Conidiobolomicosis: hallazgos histopatológicos.

Abstract

La conidiobolomicosis es una micosis subcutánea que se localiza generalmente en la línea media facial; es causada por un hongo saprófito de suelos y vegetales secos, propio de regiones intertropicales, que afecta principalmente a hombres adultos. El agente etiológico Conidiobolus coronatus pertenece a la clase de los Zigomicetos, orden Entomoftorales; se caracteriza por hifas cortas y gruesas, generalmente aseptadas, que crece entre 30°C y 37°C y produce granulomas nasales. Se informan a continuación los hallazgos histológicos de un caso de conidiobolomicosis en un paciente de 31 años de raza negra, natural y procedente de la región de Urabá, quien presentaba deformidad mediofacial con edema de nariz, labio superior e imágenes polipoides en senos maxilares con destrucción del tabique nasal. La biopsia demostró inflamación granulomatosa necrosante difusa en la dermis profunda e hipodermis asociada con eosinófilos y fenómeno de Splendore-Hoeppli, en cuya zona central se ubicaban espacios aparentemente vacíos que contenían el hongo que no se tiñó con HE, pero que sí lo hizo con las coloraciones de PAS y Grocott lo cual permitió la observación de hifas de paredes gruesas y rígidas, con torsión central y extremos cónicos.Palabras clave: conidiobolomicosis, Conidiobolus coronatus, micosis subcutáneas, entomoftoromicosis, rinoentomoftoromicosis, cigomicosis. Conidiobolomycosis: a case report with histophathologic findingsConidiobolomycosis is a subcutaneous mycosis of the facial midline affecting primarily adult males. It is caused by the saprophytic fungus, Conodiobolus coronatus, present in soils and dried vegetables, characteristic of intertropical regions. C. coronatus belongs to the class Zygomycetes, order Entomophthorales; it is a fungus composed of thick, short hyphae that grows at temperatures between 30°C and 37°C and causes nasal granulomas. The histologic findings are described of a case of conidiobolomycosis in a 31-year-old male, born and resident in the Urabá region of Colombia. He presented with a mid-facial deformity of the nose and upper lip edema, and polypoid images in the maxillary sinuses with destruction of the nasal septum. The biopsy revealed a diffuse inflammatory lesion located in the deep dermis and in the hypodermis corresponding to a necrotizing granuloma. Associated eosinophils and the presence of the Splendore-Hoeppli phenomenon were noted in the vacant central zone which apparently corresponded to location of the fungal hyphae. They did not stain with HE stain, but reacted to the PAS and Grocott staining techniques and appeared as rigid, thick-walled hyphae, centrally twisted and with cone-shaped endings.

Nasofacial Entomophthoromycosis

“…In addition, it is common to find marked infiltration by eosinophils, sometimes producing eosinophilic microabscesses. 28,29 The fungal organisms are usually inconspicuous when examined with routine histological stains, requiring impregnation of their walls with silver salts (ie, Grimelius, Grocott, or Gomori methenamine stains) or staining with periodic acid-Schiff for visualization of their morphology. The organisms are contained within palisading granulomata, surrounded by a layer of eosinophilic precipitate named Splendori-Hoeppli phenomenon in honor of the investigators who first described such finding.…”