P026 Conquering rhinofacial entomophthoromycosis: a two-drug triumph

Abstract Rhinofacial entomophthoromycosis is a rare subcutaneous fungal infection caused by Conidiobolus coronatus. It predominantly affects the nasal and facial tissues and is endemic in tropical and subtropical regions. These case reports describe two male patients, one aged 52 years and one aged 45 years, with 1-year histories of rhinofacial swelling, initially posing a diagnostic challenge. These cases of rhinofacial entomophthoromycosis were treated successfully with oral itraconazole and a supersaturated potassium iodide two-drug regimen in challenging cases, underscoring the regimen’s therapeutic potential. Both of these patients presented with a history of progressive swelling of the nose, cheeks and forehead for about 1 year with difficulty in opening the mouth and mild dysphagia. Clinical examination revealed diffuse, firm, mildly tender, indurated subcutaneous swelling involving the external nose and bilateral malar prominences, and the left side and central aspect of the forehead. The facial deformity resembled the classical ‘hippopotamus facies’. Imaging showed soft-tissue thickening without bone erosion, suggestive of an infectious pathology. Histopathology demonstrated eosinophilic infiltration and fungal hyphae consistent with C. coronatus. The patients were treated with a combination of itraconazole (200 mg twice daily) and supersaturated potassium iodide (1 g mL−1, oral drops titrated to tolerance). Therapy was continued for 6 months with regular clinical follow-ups. Clinical assessment was done by measuring head circumference and extent of induration before medication, then after 1 week, and 2 months of treatment (Table). The assessments demonstrated a notable reduction in swelling and resolution of symptoms within a few days of medication, indicating a favourable response. The patients achieved complete clinical remission at 6 months, with no evidence of relapse. The regimen was well tolerated, with no side-effects. In conclusion, these cases highlight the effectiveness of a combined itraconazole and potassium iodide regimen for rhinofacial entomophthoromycosis. The disease, although rare, is increasingly recognized due to improved diagnostic capabilities and awareness. The two-drug regimen offers a promising therapeutic approach, providing rapid clinical improvement and sustained remission with minimal side-effects. Further research is needed to establish standardized protocols and explore the role of adjunctive therapies in managing this emerging fungal disease.TableClinical assessment. Measurements are in cmSiteBaselineAfter 1 weekAfter 2 monthsCase1212121. Forehead50.855.950.055.447.054.62. Bridge of the nose49.356.448.356.445.753.33. Tip of nose53.358.448.353.345.752.84. Philtrum61.056.455.953.154.649.5