Subcutaneous Zygomycosis: A Report of One Case Responding Excellently to Potassium Iodide

Subcutaneous entomophthoramycosis in a child presenting as panniculitis: a case report from Bihar, India

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The article reports a rare case of subcutaneous entomophthoramycosis.

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The patient was misdiagnosed with non-infective panniculitis, which led to extensive involvement.

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Subsequently, the patient was diagnosed correctly using standard techniques which included KOH wet mount, culture and isolation.

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Lactophenol cotton blue mount was performed for identification of the organism as Basidiobolus spp.

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The patient was cured after treatment with itraconazole and potassium iodide.

A 5-year-boy from Bihar, India was admitted to a tertiary care hospital with painful swelling over both lower limbs and buttocks, which had been increasing progressively for the past 1 year. The condition was initially undiagnosed and was later misdiagnosed as non-infective panniculitis, delaying treatment. Subsequently, the patient was diagnosed with subcutaneous entomophthoramycosis caused by Basidiobolus spp. A preliminary diagnosis was made by considering the history, clinical features, radiological findings and histopathological examination of the biopsied tissue. The confirmatory diagnosis was made using conventional techniques on aspirated pus, which included KOH wet mount and fungal culture on Sabouraud dextrose agar tubes incubated at 28°C and 37°C, respectively. Lactophenol cotton blue mount and slide culture were performed for identification of the fungal isolate. The patient responded well to oral itraconazole and oral potassium iodide.

Delayed diagnosis and extensive involvement in a rare case of subcutaneous entomophthoramycosis causing panniculitis emphasizes the importance of correct diagnosis and appropriate, effective treatment.

Successful potassium iodide treatment for rhinofacial pythiosis in sheep

BACKGROUND

Pythiosis in sheep is an important disease in Brazil, which could cause rhinitis, dermatitis and alimentary tract inflammation. It is caused by the aquatic oomycete, Pythium insidiosum. The rhinofacial pythiosis causes facial deformity and upper respiratory tract clinical signs associated with necroproliferative masses occupying the rostral nasal cavity and hard palate. Little is known regarding the therapy, prophylaxis and pathogenesis of this disease.

METHODOLOGY

During the 6-year study, we examined 13 sheep presenting rhinofacial pythiosis. The diagnosis was performed through biopsy of the rhinofacial lesions followed by histopathology and immunohistochemistry using specific antibodies against P insidiosum, polymerase chain reaction and an indirect enzyme-linked immunosorbent assay.

RESULTS

This study presents the clinical findings of a potassium iodide treatment of rhinofacial pythiosis in sheep. All sheep were treated with 10 ml of 10% potassium iodide solution, administered orally every day during 63-120 (mean 85) days. Among treated sheep, 84.6% demonstrated complete recovery.

CONCLUSION

Potassium iodide therapy may treat rhinofacial pythiosis in sheep.

Basidiobolomycosis: Case Report and Literature Overview

Basidiobolomycosis or subcutaneous zygomycosis or subcutaneous phycomycosis is a chronic granulomatous infection of skin and subcutaneous tissue, caused by a saprophytic filamentous fungus, Basidiobolus ranarum, clinically characterized by firm, painless subcutaneous swelling with smooth and rounded edges. Histopathological features include the peculiar Splendore–Hoeppli phenomenon. Culture on Sabouraud dextrose agar shows creamy white, heaped up, and furrowed colonies. This entity has been reported from tropical and subtropical regions of the world and the southern part of India. We report a case of Basidiobolomycosis in a seven-year-old girl from Eastern India, which was excised twice before presenting to us. We diagnosed the case as Basidiobolomycosis based on clinical features, histopathology, and culture findings, and treated it with itraconazole.

An instance of excellent response of subcutaneous zygomycosis to itraconazole monotherapy

Subcutaneous zygomycosis is a rare fungal infection caused by Basidiobolus ranarum. This entity is usually endemic in South India and only limited numbers of cases have been reported from central India. We report a case of 4-year-old male child from Chhattisgarh, who presented with a painless, non-tender, large, subcutaneous swelling of 4 months duration on the right upper arm, which was initially misdiagnosed as benign spindle cell tumor and advised surgical resection. But the fungal culture of the affected tissue grown Basidiobolus ranarum and the child responded very well to itraconazole therapy only.

Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study

OBJECTIVES

Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients.

METHODS

The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study.

RESULTS

KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1-26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases.

CONCLUSIONS

Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) were observed.

Cutaneous basidiobolomycosis: Seven cases in southern Benin

BACKGROUND

Cutaneous basidiobolomycosis is the most common form of entomophthoramycosis. Herein we report seven cases of cutaneous basidiobolomycosis.

PATIENTS AND METHODS

A retrospective observational study was conducted at the Buruli ulcer treatment centre in Pobè and at the national teaching hospital in Cotonou from 2010 to 2015.

RESULTS

Seven cases of cutaneous basidiobolomycosis were diagnosed. The mean patient age was 9.53 years. There were 4 female and 3 male patients, all from southeast Benin. Clinically, the disease presented in all cases as a hard, well-defined, subcutaneous plaque with little inflammation, and which could easily be lifted from the deep structures but remained attached to the surface structures. The overlying skin was hyperpigmented. Plaques were localized to the buttocks or thighs. All patients had inflammatory anaemia with an accelerated erythrocyte sedimentation rate (30 to 70mm over the first hour), and a low haemoglobin count (8.7 to 11.4g/dL). Blood hypereosinophilia (650 to 3784elements/mm³) was present in six of the seven subjects. Histopathology (performed for 5 of the 7 subjects) showed granulomatous lesions with foreign-body giant cells, and inflammatory cells, with occasional eosinophils surrounding fungal hyphae (Splendore-Hoeppli phenomenon). Mycological analysis revealed Basidiobolus ranarum in three cases. The patients were treated with ketoconazole (5/7) and itraconazole (2/7), with good outcomes after 10 to 24 weeks of therapy.

DISCUSSION

Cutaneous basidiobolomycosis is uncommon in southern Benin, with only seven cases being diagnosed over 6 years. The diagnosis of cutaneous basidiobolomycosis is a challenge in the field in Benin due to the non-specific clinical presentation, the lack of technical resources, and the existence of numerous differential diagnoses.

CONCLUSION

Cutaneous basidiobolomycosis is an uncommon fungal infection in southern Benin chiefly affecting children.