Entomophthoromycosis (Subcutaneous zygomycosis) is an intravenous fungal infection categorized by formation of firm, non-tender swellings, generally on the extremities, trunk. This fungal infection appearance may impressionist soft tissue tumor in its appearance and there is a need to keep in mind this diagnosis in prevalent areas so that early recognition can be done and deformity resulting from the advanced disease can be prohibited. The disease occurs in age group of 20-60 years but hardly reported inchildren below 15 years. 

Here we present a case of 12 year old child with multiple subcutaneous nodules in right forearm presenting features of entomophthoromycosis and successfully treated with itraconazole.

A 12-year-old girl came with complaints of numerous progressively increasing painless swellings over the left forearm and hand since 8 months.

Her examination displayed multiple nontender indurated subcutaneous swellings 1-2cm size concentrated over dorsal surface of forearm and hand with incision scar over ventral aspect.

Entomophthoromycosis is a curable condition which can mimick a neoplasm like soft tissue tumor, synovial sarcoma, and Burkitt’s lymphoma.

She was put on antifungal treatment with itraconazole, and followed up after 15 days showed decrease in the size of lesions and limb swelling. She was asked to continue on itraconazole for 6 months.

Entomophthoromycosis should be in the differential diagnosis of subcutaneous swellings in tropical areas because the condition is potentially curable. Treatment should be started based on the histopathology report with potassium iodide and azoles especially itraconazole.

Suggested Reading

1. S.K. Kabra, Y. Jain, T. Sudhin, K.V. Iyer, Sunil A. Ninan, V. Seth. Successful Treatment ofEntomophthoromycosis with Itraconazole. Indian Pediatrics Volume 35-february 1998.
2. Dr. Jyothi k. Kudrimoti, Dr. Savita S. Patil, Dr.Somnath S Khedkar, Dr.Medha M. Khandekar, Dr.Shaila C. Puranik. Subcutaneous Entomophthoromycosis mimicking soft tissue tumour: Reportof two cases in Maharashtra, India. Paripex - Indian Journal of Research, Volume: 3 | Issue: 2 |Feb 2014.
3. Mortez ML, Grist WJ, Sewell CW. Zygomycosis presenting as nasal polyp in a healthy child. Arch Otolaryngol Head Neck Surg 1987; 113: 550-552.
4. Williams AO. Pathology of Phycomycosis due to species Entomophthora and Basidiobolus species. Arch Path 1969; 87: 13-20