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Atypical presentation of entomophthoromycosis caused by Conidiobolus coronatus

2010; Oxford University Press; Volume: 48; Issue: 8 Linguagem: Inglês

10.3109/13693786.2010.497973

1460-2709

Diogo Bento, Raquel Tavares, María da Luz Martins, Natália Faria, Ana Paula Maduro, Carlos Eugénio Nabuco de Araújo, Fernando Ventura, Kamal Mansinho,

Actinomycetales infections and treatment

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.