Conidiobolomycosis: a diagnostic challenge (case report)

Abstract

Introduction and importance: Conidiobolomycosis is a rare chronic granulomatous fungal infection affecting the rhino-facial region. It usually occurs in immunocompetent males with agricultural exposure. A high index of suspicion is required to achieve a timely diagnosis in such cases, as the infection usually responds well to early antifungal therapy. Case presentation: We share a case of this disease occurring in a 21-year-old male presenting with a right nasal mass and external nasal swelling. It could not be diagnosed correctly over 2 months at various hospitals before he visited our center, where we excised the mass via functional endoscopic sinus surgery and identified Conidiobolus coronatum as the causative agent based on histopathologic examination, and MALDI-TOF. The facial deformity resolved after 3 months of therapy with oral Voriconazole. Clinical discussion: In this report, we discuss the pathogenesis of Conidiobolomycosis, our diagnostic approach, and the use of functional endoscopic sinus surgery, which has not been reported extensively in the existing literature. Conclusion: In endemic regions, conidiobolomycosis should be considered amongst the differential diagnosis of a nasal mass associated with facial swelling. A multidisciplinary team approach is required to arrive at a timely diagnosis and begin early antifungal therapy.