IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 419 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Case Report
    Discussion
    References

 Article Access Statistics
    Viewed5214    
    Printed88    
    Emailed4    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 2    

Recommend this journal

 
CASE REPORT
Year : 2002  |  Volume : 68  |  Issue : 5  |  Page : 303-304

Subcutaneous phycomycosis in a child


Department of Dermatology and Pathology, Raja Muthiah Medical College & Hospital, Annamalai University, Annamalai Nagar- 608 002, India

Correspondence Address:
Department of Dermatology and Pathology, Raja Muthiah Medical College & Hospital, Annamalai University, Annamalai Nagar- 608 002, India

   Abstract 

Subcutaneous phycomycosis is a rare entity. We hereby report a case of subcutaneous phycomycosis on the chestwall in a one and a half year old child. Excision of the lesion was followed by a recurrence. Oral potassium iodide completely cured the disease.

How to cite this article:
Prasad P V, Paul EK, George RV, Ambujam S, Viswanthan P. Subcutaneous phycomycosis in a child. Indian J Dermatol Venereol Leprol 2002;68:303-4


How to cite this URL:
Prasad P V, Paul EK, George RV, Ambujam S, Viswanthan P. Subcutaneous phycomycosis in a child. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2019 Mar 20];68:303-4. Available from: http://www.ijdvl.com/text.asp?2002/68/5/303/12505



   Introduction Top

Subcutaneous phycomycosis is one of the deep fungal infections caused by zygomatous species which is normally found in the tropical countries.[1] The organism responsible can be either Basidiobolus ranarum or Conidiobolus coronatus.[2],[3],[4] The basidioholus infection is seen in pediatric age group, where as conidiobolus is seen in adults[1],[2],[3],[4], The organism is found in the leaf detritus and frog dung. After inoculation into the skin, it produces a slowly spreading painless " woody" subcutaneous swelling, which is usually single. The swelling may be lobulated with rounded edges and can be raised up by inserting the fingers underneath it. The disease rarely involves the bone.[4] Oral potassium iodide is the treatment of choice.[4]

   Case Report Top

A one and a half - year - old male child was seen with complaints of a swelling on the anterior chest wall of three months duration. On examination a nodule measuring 3 cm in diameter was noticed on the anterior chest wall, which was non - tender. A diagnosis of subcutaneous phycomycosis was made on the basis of clinical features. The swelling was completely excised. Histopathological examination confirmed the clinical diagnosis. [Figure - 1]. After one month, patient returned with a new nodule adjacent to the previous lesion measuring about 2 cm in diameter. Nodule was dull erythematous and non - tender. Lesion could be lifted up by inserting the fingers beneath it. Investigations done routinely revealed an eosinophilia (14%), others being normal. Skin biopsy was repeated which was consistent with subcutaneous phycomycosis. Organism could not be isolated in culture due to technical problems. Patient was started on syrup potassium iodide (5 drops to start with and increased to 5 drops / days). The nodule resolved completely after one month of treatment and there was no recurrence within 6 months of follow up period.

   Discussion Top

Subcutaneous phycomycosis has typical clinical features which makes the diagnosis easier. Basidiobolomycosis occurs almost exclusively in children. The sites involved are upper part of the limbs and buttock.
Our patient presented with the lesion at the age of 1 years. Though the diagnosis was simple, the age group and the site were unusual. The entry of the organism at the unusual site may be explained by direct injury during the child's activities. Seven cases of subcutaneous phycomycosis in the paediatric age group were earlier described from Pondicherry.[5]
It has been reported that surgery may hasten the spread of infection.[4] The relapse of the lesion in our patient after an excisional biopsy may be explained by this. Histopathological examination is useful in confirming the diagnosis. The organism can be demonstrated histologically in the subcutaneous tissue. The main features are (1) extensive dermal and subcutaneous fibrosis (2) clusters of inflammatory cells especially eosinophils and (3) large zygomatic hyphae. The hypae appears as short sections of broad hyphae without septae, and segments often appear devoid of cytoplasm. Some may be surrounded by an eosinophilic material which is called as' Splendore - Hoepplie' phenomenon.[6] As when our patient was given full therapeutic doses of oral potassium iodide the lesion resolved and a follow up after six months was uneventful. 

   References Top

1.Allen HB. Subcutaneous mycosis. In: Moschella SL Hurley HJ eds. Dermatology. New Delhi : JP Brothers, 1987: 786 - 787.  Back to cited text no. 1    
2.Hay RJ, Moore M. Mycology. In : Champion RH, Burton JL, Burns DA, Breathnach SM, eds. Textbook of Dermatology. 6th edn. Oxford: Blackwell Science, 1998: 1361.  Back to cited text no. 2    
3.Charles DV Identification of agent of subcutaneous mycosis. In: Evans EGV, Richardson MD, eds. Medical Mycology. Oxford: IRL Press, 1989: 129 - 132.  Back to cited text no. 3    
4.Roberts SOB, Hay RJ, Mackenzie DWR. Subcutaneous mycosis. In: Dekker Marcel ed. A Clinician's Guide to Fungal Disease. New York: INC, 1984:116-9.  Back to cited text no. 4    
5.Lal S, Baruah MC, Padiyar N V, et al. Clinicopathological study of subcutaneous phycomycosis. Indian J Dermatol Venereal Leprol 1984; 50: 245 - 248.  Back to cited text no. 5    
6.Burkitt DP, Wilson A M, Jelliffe DB. Subcutaneous phycomycosis. A review of 31 cases seen in Uganda. Brit Med J 1964;1: 1669 - 1672.  Back to cited text no. 6    

 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow