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Subcutaneous entomophthoromycosis mimicking soft-tissue sarcoma in children
Venkatachalam Raveenthiran1, Vincent Mangayarkarasi2, Murugesan Kousalya2
1Department of Pediatric Surgery, Sri Ramasamy Memorial (SRM) Medical College, Kattankulathur, Chennai, India; Hindu Mission Hospital, Tambaram, Chennai, India.
Aim:
Subcutaneous entomophthoromycosis (EM) is an uncommon fungal infection of childhood. This article is intended to draw the attention of pediatric surgeons to the fact that EM can mimic soft-tissue tumor.
Methods:
It is a retrospective review of 16 children treated for subcutaneous EM between 2000 and 2013.
Results:
The median age of patients was 3.5 years. The typical lesion was a discoid subcutaneous mass that can be easily lifted from deeper tissues (the doughnut lifting sign). Lesions were mostly distributed in the lower half of body. All the patients were immunocompetent. Correct clinical diagnosis was made only in 4 cases while others were mistaken for a tumor. All the 8 children who underwent wide excision of the pseudotumor had local recurrence. Supersaturated solution of potassium iodide was curative in 11 cases while addition of itraconazole was needed in one case. One child died of multi-drug resistant infection. The mean treatment duration was 4.7 months (range 2-8 months).
Conclusion:
Subcutaneous EM can mimic soft-tissue tumor. High index of suspicion is essential to avoid misdiagnosis and inappropriate treatment. A newly described "doughnut-lifting sign' may be helpful in clinical diagnosis. Emergence of multi-drug resistant infection is a source of concern.
Insights
Subcutaneous entomophthoromycosis (EM) in children often mimics soft-tissue tumors, leading to misdiagnosis. Early recognition, aided by the "doughnut-lifting sign," is crucial for effective treatment and preventing recurrence.
Area of Science:
- Pediatric Surgery
- Mycology
- Infectious Diseases
Background:
- Subcutaneous entomophthoromycosis (EM) is a rare fungal infection in children.
- It frequently presents as a soft-tissue tumor, complicating diagnosis.
Purpose of the Study:
- To highlight subcutaneous EM's potential to mimic soft-tissue tumors in pediatric patients.
- To emphasize the importance of early diagnosis and appropriate management.
Main Methods:
- Retrospective review of 16 pediatric cases of subcutaneous EM treated between 2000 and 2013.
- Analysis of clinical presentation, diagnostic challenges, treatment outcomes, and recurrence rates.
Main Results:
- The median patient age was 3.5 years, with lesions typically presenting as discoid subcutaneous masses.
- Misdiagnosis as a tumor occurred in most cases; wide excision led to recurrence.
- Supersaturated potassium iodide solution was effective, with one case requiring itraconazole.
- One patient died from a multi-drug resistant infection.
Conclusions:
- Subcutaneous EM can be mistaken for soft-tissue tumors, necessitating a high index of suspicion in pediatric surgery.
- The "doughnut-lifting sign" may aid in clinical diagnosis.
- Emerging multi-drug resistant infections pose a significant concern.
