Atypical presentation of entomophthoromycosis caused by Conidiobolus coronatus.
A male patient from Guinea-Bissau was admitted to Egas Moniz Hospital, Lisbon, complaining of fever and exhibiting a productive cough with mucopurulent discharge and weight loss. He had been using empirical medication with dexamethasone to treat his generalized facial swelling. At admission, he was cachectic and presented with soft facial edema, oropharyngeal thrush, and two fistulas of the palate. Acid-fast bacilli were detected in the sputum and were later identified as Mycobacterium tuberculosis. Cultures of the palatine exudate and biopsy resulted in the growth of Candida albicans. The patient was administered antituberculosis drugs and fluconazole, but his clinical situation deteriorated progressively. Extensive investigation of his clinical condition did not result in a conclusive diagnosis until he began to experience respiratory distress and subcutaneous nodules appeared on his face. Biopsies of the hypopharynx and nodules revealed the presence of Conidiobolus coronatus. After initiating combined antifungal and antibiotic therapy, the patient's clinical condition improved significantly. We report an unusual presentation of entomophthoromycosis and describe the clinical difficulties that delayed this diagnosis.
Bento
Diogo Ponces
DP
Department of Infectious Diseases and Tropical Medicine, Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. diogo_pb@sapo.pt
Tavares
Raquel
R
Martins
Maria Da Luz
Mda L
Faria
Natália
N
Maduro
Ana Paula
AP
Araújo
Carlos
C
Ventura
Fernando
F
Mansinho
Kamal
K
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D002176:Candida albicans / Q000302:isolation & purification; D020092:Conidiobolus / Q000302:isolation & purification*; D005145:Face / Q000473:pathology; D006169:Guinea-Bissau; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009960:Oropharynx / Q000473:pathology; D010159:Palate / Q000473:pathology; D011174:Portugal; D012128:Respiratory Distress Syndrome / Q000175:diagnosis; D016896:Treatment Outcome; D020096:Zygomycosis / Q000175:diagnosis* / Q000473:pathology*
D000935:Antifungal Agents