Zygomycosis Presenting as Nasal Polyps in a Healthy Child

Abstract

\s=b\A 15-year-old boy presented with unilateral nasal polyps. Pathological examination showed submucosal granulomas and fungal organisms with occasionally septate hyphae. These organisms were identified by the Centers for Disease Control, Atlanta, as being members of the class of fungi known as Zygomycetes (formerly Phycomycetes). Based on strong morphological and clinical criteria, we believe the causative organism to be Entomophthora coronata. The patient had no evidence of diabetes mellitus or compromised immunity. This patient represents an unusual case of nasal polyps caused by an organism that has rarely been diagnosed in North America. (Arch Otolaryngol Head Neck Surg 1987;113-550:552) Zygomycetes is the only medically important class of the large group of fungi known as Phycomy¬ cetes. Within this class are two orders of organisms that are able to produce disease in humans: Mucorales and Entomophthorales. Most otolaryngol¬ ogists are familiar with the fulminant malignant infections of the nose and paranasal sinuses produced by Muco¬ rales. Less well known and much less common, however, are the diseases produced by the other Entomophtho¬ rales. Despite the rarity of the orga¬ nism, we present a healthy young man with a relatively common clinical problem-nasal polyposis, which we believe was caused by Entomophthora coronata. recent report of a similar infection in the maxillofacial region and, to our knowledge, presents the second case reported in the continental United States.1 Considering the ubiquity of these organisms, it is surprising that these infections are not more com¬ mon. Our goal in presenting this case is to heighten awareness and to increase knowledge of these orga¬ nisms. REPORT OF A CASEA previously healthy 15-year-old boy was seen in the Emory University Clinic, Atlanta, for evaluation of left nasal polyp¬ osis. Two years earlier, he had sustained an injury to his contralateral eye after a fall. Moderate swelling of the right periorbital tissues occurred, but there was no facial fracture. Approximately six months later, he began to experience left-sided nasal obstruction and discharge, which did not improve with antibiotics or antihistaminedecongestant medications. Because of a family history of allergy, he was referred to an allergist, who found moderate reac¬ tions on skin testing with a limited number of antigens. Nasal polyps were noted in the ethmoidal region of the left side along with a thick purulent nasal discharge. Culture of this material for bacteria and fungus yielded a heavy growth of Staphylococcus aureus but no fungus. Sinus roentgeno¬ grams showed complete opacification of the left sinuses, but the right side was clear. A computed tomographic scan was obtained, which showed a nonenhancing high-density mass filling the left ethmoi¬ dal sinus, with lateral bowing of the medial wall of the orbit and rightward displace¬ ment of the nasal septum (Fig 1). There was no apparent orbital or intracranial invasion.The patient was admitted to the Hen¬ rietta Egleston Hospital ...

Rhinofacial conidiobolomycosis: Clinical and microbiological characterisation and shift in the management of a rare disease

“…Conidiobolomycosis due to Conidiobolus incongruous is seen in only 0.5% of cases affecting lungs or mediastinum. Even though the microbiological examination with the isolation of the causative fungus on culture is confirmatory, the positivity rate is low 16 . In this series, 81.8% grew Conidiobolus spp.…”

“…Even though the microbiological examination with the isolation of the causative fungus on culture is confirmatory, the positivity rate is low. 16 In this series, 81.8% grew Conidiobolus spp. on fungal culture and all of them were identified as C coronatus.…”

Orofacial Conidiobolomycosis due to Conidiobolus incongruus

“…The culture of the causative fungus is confirmatory, although often unsuccessful. 12 The other routine laboratory investigations are usually normal. In the histopathology, a tuberculoid granulomatous infiltrate permeates the deep dermis and may replace the subcutaneous fat.…”

“…The diagnosis of conidiobolomycosis is usually based on clinical presentation and the histopathology. The culture of the causative fungus is confirmatory, although often unsuccessful 12 . The other routine laboratory investigations are usually normal.…”

A Rare Case of Subcutaneous Entomophthoromycosis in a 11 Year S Old Child Mimicking Soft Tissue Tumor Treated With Itraconazole: Case Report

“…2 This class contains teo orders of organisms that cause disease in humans, i.e., Mucorale and Entomophthorale. 4 Entomophthoromycosis cases have been reported from tropical countries like Nigeria, Ghana, India, Sudan, Uganda and Indonesia. 5 The infection usually occurs as small papules following a scratch or puncture by an insect, plant, or fungus-bearing object.…”