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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 564-565
Entomophthoromycosis of face


Department of Pathology, Alluri Seetharama Raju Academy of Medical Sciences, ELURU, W.G.Dt., Andhra Pradesh, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Chokka KM, Reddy SR, Rayi NR, Pullela R. Entomophthoromycosis of face. Indian J Pathol Microbiol 2010;53:564-5

How to cite this URL:
Chokka KM, Reddy SR, Rayi NR, Pullela R. Entomophthoromycosis of face. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Dec 6];53:564-5. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/564/68276


Entomophthoromycosis is a rare sporadic subcutaneous slow growing fungal infection observed in healthy individuals and also in diseases like diabetes mellitus where immune deficiency is present. These cases are largely restricted to tropical areas of Africa, Asia and South America. [1] The causative fungi Basidiobolus ranarum infection, which causes subcutaneous infection [2] and Conidiobolus coronatus producing rhinofacial infection belong to Entomophthorales, which resemble mucormycosis; unlike the former Mucor that occurs in immune deficiency and has a predilection for vascular invasion and thrombosis. [3] Many Indian authors reported subcutaneous infections of entomophthoromycosis especially from south India. [4] The present case was a 56-year-old male presented with a slow growing, painless mass of 6 Χ 4 cm in the glabellar region of four months duration, without any inflammatory signs. The patient was a farmer and did not have any history of injury and constitutional disturbances. Routine laboratory investigations were normal except slightly raised blood sugar. The mass was excised subcutaneously and found to be adherent to the anterior plate of frontal bone from which it was curetted. The mass was irregular firm grey yellow measuring 5 Χ 3.5 Χ 1.5 cm. Multiple histological sections revealed foci of neutrophilic abscesses and foreign body granulomatous reaction including Langhans giant cells. [Figure 1] Numbers of nerve fibers were also observed. A tentative diagnosis of either fungal infection or tuberculoid Hansen was considered. Fitefaracco, PAS and methanamine silver stains were carried out wherein typical broad, thin-walled, partially septate widely branching hyphae with clubbed ends were identified [Figure 2] and diagnosed as entomophthoromycosis.
Figure 1: Note multi ple granulomas (H and E, ×400)

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Figure 2: Methanamine silver stain revealing fungal hyphae (Methanamine silver stain, ×400)

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Entomophthoromycosis is a slowly progressive subcutaneous infection, which is more common in tropical countries like India, Africa and Indonesia. [1] Sujatha et al. quoted that subcutaneous zygomycosis caused by B. ranarum is endemic in south India. [4] Joe LK described in Indonesia B. ranarum as the causative fungus for subcutaneous infection (1956). [2] The present case was a healthy farmer except for diabetes of long duration. Histopathology is well described by Gilbert et al. who emphasized the presence of Splendore Hoeppli phenomenon, foreign body giant cells in abundance and absence of vascular invasion. [5] Our case lacks the splender Hoeppli phenomenon but plenty of foreign body giant cells were observed. HandE stain did not reveal the fungi. Gomori silver methanamine stain revealed partially septate fungal hyphae of entomophthoromycosis. No vascular invasion was observed. In immune compromised individuals and in diabetics this fungal infection should be suspected and special stains should be done to demonstrate the fungus.

 
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1.Dworzack DL, Pollock AS, Hodges GR, Barnes WG, Ajello L, Padhye A. Zygomycosis of the maxillary sinus and palate caused by Basidiobolous haptosporus. Arch Intern Med 1978;138:1274-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Joe LK, Njoimjo TE. Basidiobolous ranarum as a cause of subcutaneous phycomycosis in Indonesia. Arch Dermatol 1956;74:378-83.  Back to cited text no. 2      
3.Winn RE. Diagnosis of entomophthoromycosis. Chest 1992;102:981.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Sujatha S, Sheeladevi C, Khyriem AB, Parija SC, Thappa DM. Subcutaneous zygomycosis caused by Basidiobolous ranarum case report. Indian J Med Microbiol 2003;21:205-6.  Back to cited text no. 4  [PUBMED]  Medknow Journal  
5.Gilbert EF, Khoury GH, Pore RS. Histopathological identification of Entomophthora phycomycosis: Deep mycotic infection in an infant. Arch Pathol 1970;90:583-7.  Back to cited text no. 5  [PUBMED]    

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Correspondence Address:
Kiran M Chokka
ASRAM Medical College, ELURU, W.G. Dt. Andhra Pradesh - 534 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68276

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    Figures

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This article has been cited by
1 Basidiobolomycosis: Case report and literature overview
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[Pubmed] | [DOI]



 

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