PMC4591341_01
Portrait of the patient before, during and after treatment.. (A) The patient is shown as a healthy young adult. (B) Before treatment (month 0). (C) After treatment with fluconazole and terbinafine (month 18). (D) After 14 months without therapy (month 32).
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He complained of grotesque facial deformity (Fig 2), dysarthria, hypersalivation, and incapacity to eat properly. The patient is free of relapse after 14 months without antifungal therapy (Fig 2D).
Histopathology.. Histopathological picture of hyphae of Entomophthorales after KOH-staining (A), after hematoxylin eosin stain (HE-stain) (B and C), and after Grocott-Gomori's methenamine silver stain (GMS-stain) (D). The pauci-septated, right-angled branching fungal hyphae have an irregular diameter of 5-12 mum with drumstick-like distended ends (A). The "Splendore-Hoeppli phenomenon" is characterized by a peri-hyphal amorphous eosinophilic material (B). Fungal hyphae are visible in transversal (C) or longitudinal cuts (D).
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Histopathology revealed fungal hyphae suggestive for Conidiobolus sp. (Fig 3A, 3C and 3D) and the Splendore-Hoeppli phenomenon (Fig 3B).
Algorithm for the staging of rhinoentomophthoromycosis.. This algorithm is based on the clinical presentation of suspected/confirmed cases of rhinoentomophthoromycosis and the time since the onset of the first symptoms. The presence of a nodule at the nostril or invasion of facial tissue is the cornerstone to differentiate between early and intermediate disease.
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