Rhinofacial Conidiobolomycosis due to Conidiobolus coronatus: A case report and update of the disease in Asia

Abstract

Introduction: Rhinofacial entomophthoromycosis, is a rare subcutaneous mycosis, caused by Conidiobolus coronatus affecting the upper respiratory mucosa and adjacent subcutaneous tissues. Herein, we report a case of rhinofacial entomophthoromycosis in a farmer from Bidnapur, West Bengal, India and present the review of literature of cases published so far from Asia. Case Report: A 55-year old male presented with slowly progressive swollen nose with bilateral nasal obstruction. Also, the swelling involved the cheek and forehead. Contrast Enhanced Computed Tomography scan of the paranasal sinuses showed bilateral soft tissue thickening in the nasal cavities suggestive of polypoidal or granulomatous lesion and the involvement of the left maxillary sinus. The biopsy from the left nasal cavity revealed ill-defined epitheloid cell granuloma and chronic granulation tissue. However, the nasal skin biopsy specimen on culture grew multiple white colonies on Sabouraud glucose agar after 3 days of incubation at 280C. The isolate was identified as Conidiobolus coronatus by Internal Transcribed Spacer and D1/D2 region of ribosomal subunit of rDNA. The patient was treated with oral itraconazole 400mg/day and 10 drops three times in day of saturated solution of potassium iodide. After 8 weeks of this treatment, marked clinical improvement, as evidenced by regression of facial swelling and relief from symptoms were observed. Conclusion: Conidiobolomycosis is endemic in Asia but is under reported due to lack of clinical suspicion and mycological facilities in health care setups.