Rhino-orbital conidiobolomycosis in non-endemic Settings. A diagnostic and therapeutic challenge

Conidiobolomycosis is a rare tropical mycosis that is often difficult to diagnose and treat.

We describe here an imported case that highlights these issues.

A 24-year-old HIV positive patient was diagnosed and treated for a conidiobolomycosis due to Conidiobolus coronatus. Imaging showed extensive facial invasion. Biopsy and fungal culture confirmed conidiobolomycosis, resistant to standard antifungals. Initial therapy with liposomal amphotericin B and itraconazole failed due to drug interactions. After adjusting treatment and performing surgery, the patient's condition improved. Despite high MICs, clinical response was favorable. He completed 14 months of itraconazole without recurrence four months post-treatment. Serial beta-D-glucan assays showed promise as a reliable biomarker for therapeutic monitoring.

This case highlights the complex medicosurgical management of a rare imported tropical mycosis, the diagnostic aspects of conidiobolomycosis, and the promising potential benefit of beta-D-glucan for the management and follow-up of this severe tropical deep-sited mycosis.