title: Atypical presentation of entomophthoromycosis caused by Conidiobolus coronatus.
abstract: 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.
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. diogo_pb@sapo.pt
authors.forename: Diogo Ponces
authors.initials: DP
authors.lastname: Bento
authors.forename: Raquel
authors.initials: R
authors.lastname: Tavares
authors.forename: Maria Da Luz
authors.initials: Mda L
authors.lastname: Martins
authors.forename: Natália
authors.initials: N
authors.lastname: Faria
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Maduro
authors.forename: Carlos
authors.initials: C
authors.lastname: Araújo
authors.forename: Fernando
authors.initials: F
authors.lastname: Ventura
authors.forename: Kamal
authors.initials: K
authors.lastname: Mansinho
mesh_terms: 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*
chemical_list: D000935:Antifungal Agents