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Editor,—Entomophthoramycosis is a rare granulomatous disease caused by the fungusConidiobolus (classZygomycetes), and usually manifests as chronic, indolent, and localised infection of the rhinofacial region.1 While immunodeficiency may predispose to dissemination of infection,2 the condition usually presents in immunocompetent individuals. Standard treatment includes single or combination antifungal therapy and surgical debridement.1
We report orbital entomophthoramycosis due toConidiobolus coronatus in an infant with congenital nasolacrimal duct obstruction, which resolved following excision of granulomatous tissue, administration of antifungal and immunomodulating drugs, and use of hyperbaric oxygen.
CASE REPORT
A 5 month old infant girl presented with a swelling near the left eye. From the age of 2 months, she had received various topical and oral antibiotics for suspected bacterial dacryocystitis.
Examination revealed a thriving infant weighing 7 kg, with redness and swelling over the left lacrimal sac and candidiasis of the nappy area and mouth. While the candidiasis responded to oral and topical nystatin, the orbital swelling continued to increase despite broad spectrum, topical and systemic antibiotic therapy. Computed tomography (CT) of the orbit demonstrated a solid mass in the region of the left lacrimal sac (Fig 1). Microscopic examination of a biopsy revealed fungal hyphae, and subsequent culture on Sabouraud's agar led to identification of the fungus Conidiobolus coronatus(Fig 2). There was no evidence of underlying immunodeficiency.
Computed tomography of the orbit (with contrast, Omnipaque) 1 week after admission showing an enhancing mass lesion in the medial part of left orbit.
Conidiobolus coronatus: spherical conidia with prominent papillae. …