P235 Rhino sinusoidal Lasiodiplodia theobromae: a clinical and diagnostic dilemma

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: To disseminate and discuss a rare case of rhino sinusoidal Lasidiploidea theobromae in a known diabetic. METHOD: A case study was prospectively done since 2021 following a hospital visit of a 56-year-old male patient presenting with rhino sinusitis mimicking mucormycosis. Ethical approval and patient consent were obtained for this study. A detailed account of case progression from the date of first hospital admission to the final cure was noted. A 56-year-old male from Madhya Pradesh, in central India, presented to the outpatient department of Otolaryngology (ENT) -Head and Neck Surgery. The patient was a known case of diabetes for 5 years. He presented with a headache for 10 days, throbbing pain over the left cheek and upper teeth with nasal discharge and crusting for one week. Nasal crusting and sample from left maxillary meatus were sent suspecting rhino sinusoidal mucormycosis. Mycological evaluation by KOH wet mount showed melanized hyphae and short fragments appearing broad pauciseptate. After 10 days, a grey fluffy growth was observed at 37(°)C and 25(°)C on SDA with chloramphenicol. On SDA with cycloheximide there was no growth. LPCB mount of the growth showed some hyaline hyphae with immature hyaline conidia and at places brownish dark walled single septate conidia. Phenotypic identification was inconclusive. Debridement surgery was done and amphotericin B was initiated. The patient was discharged after 10 days with the mention of routine follow-up. The isolate was sent to PGIMER Chandigarh Mycology Reference Center India for species confirmation. After almost 3 months the species was confirmed as L. theobromae. RESULTS: After almost 1-year clinical improvement was observed. CONCLUSION: This study addresses the diagnostic dilemma both for the clinicians as well as clinical mycologists. Also, it emphasizes the need for molecular diagnostic workflow in such a scenario.