Clinical Report: Conidiobolomycosis - Two Case Studies and Review
Overview
Conidiobolomycosis is a rare subcutaneous fungal infection causing progressive nasal swelling and facial disfigurement if untreated. Two immunocompetent patients with nasal obstruction and facial swelling were successfully treated with itraconazole and potassium iodide, highlighting the importance of early diagnosis and management.
Background
Conidiobolomycosis is caused mainly by Conidiobolus species, fungi found in soil and decomposing vegetation. It predominantly affects individuals in tropical and subtropical regions, especially those with outdoor occupations. The infection typically presents as a chronic, painless nasal swelling with nasal obstruction and can lead to severe facial deformity if untreated. Diagnosis is confirmed by histopathology showing broad aseptate fungal hyphae and granulomatous inflammation.
Soft tissue lesion in left lateral nasal wall, no bone involvement
Subcutaneous thickening in left nasolabial fold, maxillary sinusitis
Treatment
Itraconazole 200 mg BID + potassium iodide
Itraconazole 200 mg BID
Outcome
Complete resolution after 6 weeks
Significant improvement by 4 weeks, complete resolution
Key Findings
Conidiobolomycosis presents as a chronic, painless nasal swelling causing nasal obstruction and facial disfigurement.
Diagnosis relies on histopathological identification of broad aseptate fungal hyphae and granulomatous inflammation.
Imaging typically shows soft tissue lesions without bone involvement, sometimes with associated sinusitis.
Itraconazole combined with potassium iodide or itraconazole alone is effective and well tolerated in immunocompetent patients.
Early diagnosis and treatment lead to complete resolution and prevent progression to severe facial deformity.
The infection predominantly affects individuals with outdoor exposure to soil and vegetation, with no underlying immunodeficiency.
Clinical Implications
Clinicians should consider conidiobolomycosis in patients presenting with chronic nasal obstruction and painless facial swelling, especially those with outdoor exposure. Early biopsy and histopathological examination are essential for diagnosis. Treatment with itraconazole, with or without potassium iodide, is effective and should be continued until complete clinical resolution to prevent disfigurement.
Conclusion
Conidiobolomycosis, though rare, is an important differential diagnosis for chronic nasal swelling and obstruction. Prompt recognition and appropriate antifungal therapy can result in excellent outcomes and prevent serious facial deformities.
Related Resources & Content
Author/Source/Year -- Conidiobolomycosis: A Frequently Ignored Condition Highlighted by Two Case Reports
by Kulasinghe Arachchige Chethana Charitha Pemasiri, Buddhika Ushani Manukulasooriya, Amal T. G. Fernanado, Ravindra Kirihena, Primali Irosha Jayasekera
