Mucocutaneous Entomophthoramycosis Acquired by Conjunctival Inoculation of the Fungus

Abstract

Entomophthoramycoses are classified into subcutaneous, mucocutaneous, and primary visceral forms. The mucocutaneous form, also known as rhinoentomophthoramycosis, involves the mucosa and subcutaneous tissues of the nose and is caused by Conidiobolus coronatus (Entomophthora coronata). In this report, we describe the first case of mucocutaneous entomophthoramycosis acquired by introduction of the fungus through the conjunctival mucosa as a consequence of trauma involving contamination with soil. The patient was a 37-year-old man with no other complaints. The lesion was tumoral and extended into the ethmoidal and maxillary sinuses. The histopathologic appearance of the lesion was characteristic of this infection with a granulomatous process rich in eosinophils and with hyphae surrounded by an eosinophilic, periodic acid-Schiff stain-positive halo (Splendore-Hoeppli phenomenon). To the best of our knowledge, this case constitutes the first report of mucocutaneous entomophthoramycosis acquired by ocular contamination.

Mucocutaneous Splendore‐Hoeppli phenomenon

“…It is common in immunosuppressed persons and is usually caused by Rhizopus and Mucor . Zygomycosis involving the skin occurs in three forms: rhinocerebral, primary cutaneous and chronic subcutaneous infections 29,31–34 . Rhinocerebral mucormycosis is the most common form.…”

“…The disease usually occurs in children, less often in adolescents and rarely in adults 29 . The histological diagnosis of zygomycosis depends on the finding of dermal vascular invasion by large (up to 30 μm in diameter) to non‐septate hyphae with irregular diameters and branching at 90 degrees associated with thrombosis, infarction and inflammation 29,31–34 . The inflammatory reaction can be suppurative or granulomatous.…”

The Spectrum of Fungi That Infects Humans

“…Presumably, the route of infection is inhalation of large ballistospores forcibly launched from the sporangiophores on which they are produced singly to distances up to 30 cm (Isa-Isa et al 2012). Owing to their large size of 30 -38 mm (Isa-Isa et al 2012), spores presumably land on the mucosa of nasal air passages and fail to reach the distal airways (Bittencourt et al 2006).…”

Nasofacial Entomophthoromycosis

“…Recently, a case of nasofacial zygomycosis with a putative conjunctival port of entry of the infectious agent after contamination with soil has been reported. 27 Conidiobolus and Basidiobolus produce similar histopathologic changes in the infected tissue of immunocompetent individuals. The inflammatory process involves the subcutaneous tissue in a fairly diffuse fashion, and there is a suggestion of nodularity on palpation.…”