Rhinofacial Entomophthoromycosis
An immunocompetent 22-year-old man from southern China presented to the dermatology clinic with a 3-month history of progressive nasal and maxillofacial swelling. He reported that during the past 3 years he had had episodes of facial swelling for which he had received multiple treatments, including glucocorticoids and antibiotics. The physical examination revealed erythema, edema, and tenderness over the nasal dorsum and forehead, extending to the soft tissue around both eyes (Panel A), that correlated with soft-tissue thickening on computed tomography. Biopsy specimens were obtained from multiple sites, including the forehead and the nose. Histopathological examination of a specimen from inside the nose revealed granulomatous inflammation and fungal elements surrounded by eosinophilic material. A fungal culture grew Conidiobolus coronatus (Panel B), the identity of which was confirmed by polymerase-chain-reaction assay. Rhinofacial entomophthoromycosis was diagnosed. Conidiobolomycosis, a type of entomophthoromycosis, is a rare subcutaneous mycosis that can occur in immunocompetent persons in tropical and subtropical regions. It affects the upper respiratory mucosa and adjacent subcutaneous tissues. Infection probably results from the inhalation of fungal pathogens or from trauma. The patient received itraconazole, trimethoprim–sulfamethoxazole, and a 10% potassium iodide solution for 6 months, and the symptoms had fully resolved without relapse after 1 year of follow-up.