|Year : 1992 | Volume
| Issue : 3 | Page : 192-194
Pyrexial therapy in subcutaneous phycomycosis
BSN Reddy, A Sourianarayanane, BR Garg, C Ratnakar
Source of Support: None, Conflict of Interest: None
A case of subcutaneous phycomycosis occurring in a 2 ½ year old child is reported for its rarity, clinical interest and paucity of literature. The condition failed to resolve with conventional antimycotics but improved with the administration of concomitant pyrexial therapy.
Keywords: Subcutaneous phycomycosis, Antimycotic drugs, Pyrexial therapy
|How to cite this article:|
Reddy B, Sourianarayanane A, Garg B R, Ratnakar C. Pyrexial therapy in subcutaneous phycomycosis. Indian J Dermatol Venereol Leprol 1992;58:192-4
|How to cite this URL:|
Reddy B, Sourianarayanane A, Garg B R, Ratnakar C. Pyrexial therapy in subcutaneous phycomycosis. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Jun 19];58:192-4. Available from: http://www.ijdvl.com/text.asp?1992/58/3/192/3792
| Introduction|| |
Subcutaneous phycomycosis (SCPM) occurs as an acute fulminant cutaneous or systemic infection in immunocompriomsed individuals. However, sometimes it is encountered in normal individuals in tropical countries with chronic disease affecting the subcutaneous tissue of the abdomen, back, buttocks, and legs.  This condition, also called subcutaneous zygomycosis, presents as a painless, firm to hard swelling with indurated edges below which the fingers can be inserted. Basidobolus haptosporus (ranarum) is the usual causative organism and can be seen in histopathologic sections as mycelia invading the' vessel wall. 
Spontaneous involution is known and many conventional modalities of therapy such as potassium iodide, imidazoles, amphotericin - B and surgical excision  are available, yet, the treatment of SCPM is problematic at times. because of its chronic course. There are a few reports of cutaneous pheohypomycosis treated with topical heat therapy , but none of SCPM to our knowledge. We report a case of this disorder that failed to resolve with conventional antimycotics but improved with the administration of concomitant pyrexial therapy.
| Case Report|| |
A baby girl aged 2 years presented with the complaint of gradually progressive, painless swelling over right buttock for 7 months. No preceding history of either local trauma or constitutional features was present.
There was an irregular, lobulated, firm, non-tender swelling over the right buttock with no signs of local warmth over it. The lesion was of 20 x10 cm size, extending from right buttock to the upper thigh posteriorly [Figure - 1]. The edges were well defined, fingers could be inserted below it. The swelling was immobile over the underlying structures. Mobility of the hip joint was restricted and the right inguinal lymph nodes were significantly enlarged, firm, and discrete. Systemic examination was normal.
Routine laboratory investigations were within normal limits except for an increased ESR. X-Rays of the chest and right hip were normal. Incisional biopsy and histology of the swelling revealed granulomas consisting of predominantly neutrophilic, eosinophilic and lymphohistiocytic infiltrate with Langhan's gaint cells on H and E staining. Mycelial structures invading the vessel wall were seen on PAS staining [Figure - 2][Figure - 3]. KOH examination and culture of the biopsy material for mycotic organisms were non-productive.
The child was diagnosed as a case of SCPM and potassium iodide oral drops were administered 1 gm per day. The swelling responded by decreasing in size to 10 x 7 cm in the first few weeks but later it continued to increase in size (14 x 10 cm) despite doubling the dose of potassium iodide over a period of 4 weeks. Addition of ketoconazole did not improve the condition.
The child developed respiratory tract infection with high grade fever of 110 ° F which was treated with oral erythromycin and paracetamol. On the third day of fever, softening of the swelling was noticed followed by reduction in the size to 9 x 11 cm. Similar improvement was noted in inguinal lymphadenopathy also. Impressed by the clinical improvement of lesions after fever, the child was administered local heat therapy with infrared radiation lasting 15 minutes daily for 2 weeks in addition to the oral antimycotics. However, no improvement occurred. Hence, a spike of fever (102 0 F) was induced by administering a single dose of DPT vaccine. With this, there was a marked decrease in the size of swelling (4 x 2 1/2 cm) and complete regression of inguinal lymphadenopathy [Figure - 4].
| Comments|| |
SCPM is usually seen in adolescents and young adults predominantly involving the subcutaneous tissue, muscles and underlying structures of the affected parts but rarely the regional lymph nodes.  Inguinal lymphadenitis responded to the treatment in our patient, this suggests that regional lymph nodes were affected by the disease.
Silva  observed the death of fungi in vitro by raising the temperature to 46 ° C and advocated its probable therapeutic application. Topical heat therapy with a local device (pocket warmer) was tried for cutaneous phaeohypomycosis with regression of the lesions by Tagami et al.  Dooley et a1  also observed the beneficiary effect of topical heat in the treatment of mycosis. In the above cases the pathology was in the superficial layers unlike the patient of SCPM reported herein. The deeper location of lesions may be the reason for the fact that application of local heat had no effect in our patient.
| References|| |
|1.||Binford H C, Dooley J R. Diseases caused by fungi and actinomycetes. In : Pathology of tropical and extraordinary diseases, Vol 2 (Binford C H, Cannon D H, eds). Washington : Armed Forces Institute of Pathology, 1976; 551. |
|2.||Lever W F, Lever G S. Fungal diseases. In Histopathology of the Skin, 6th edn. Philadelphia : 1983; 335. |
|3.||Arnold H L, Odom R B, James W D. Diseases due to fungi and yeasts. In: Diseases of the Skin - Clinical Dermatology, 8th edn. Philadelphia: W B Sauders Company, 1990; 365. |
|4.||Tagami H, Mastoshi 0 H, Aoshima T, et al. Topical heat therapy for cutaneous chromomycosis. Arch Dermatol 1979; 115: 740-74. |
|5.||Dooley D P, Beckins M L, Jeffery B S, et al. Phaeohypomycotic cutaneous disease caused by Plemophoria in a cardic transplant patient, J Infect Dis 1989; 159: 503 - 7. |
|6.||Silva M. The saprophytic phase of the fungi of chromomycosis. Effect of nutrients and temperature upon growth and morphology. Trans N Y Acad Sci 1958; 21 : 46 - 57. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]