Child With Asymmetric Swelling of Face, Neck, and Trunk: A Case of Entomophthoromycosis With Diagnostic Dilemma

Entomophthoromycosis is a rare skin and subcutaneous fungal infection predominantly common in the tropical regions with diagnostic challenges in the pediatric population. Herein, we report a case of a 2-year-old boy with an asymptomatic slowly progressive unilateral swelling of the face and upper chest over a 9-month period who presented to us with atypical shiny dome-shaped, hard swelling with loss of skin pinchability and cervical lymphadenopathy. Fine needle aspiration cytology from one of the lymph nodes demonstrated necrotizing granulomatous inflammation and histology from one of the swellings over the chest revealed necrotizing granuloma in the dermis, multinucleated giant cells, intracytoplasmic hyphae, and positive PAS staining. Subsequently, he was started on a supersaturated solution of potassium iodide and Itraconazole following which there was complete resolution.