A chest roentgenogram disclosed old apical scars in the
lungs consistent with tuberculosis. The leukocyte
count was normal, except for an eosinophilia of
11%. Hemoglobin and hematocrit were within
normal limits. Total serum protein was 8.1 g/dl,
with 4.2 g/dl of albumin and 3.9 g/dl of globulin.
Serum cholesterol was 200 mg/dl. A PPD (2 U)
skin test was positive at 17 mm. A bone marrow
examination from the iliac crest was diagnosed as essentially normal, except for a low iron reserve. The erythrosedimentation rate was 44 mm/h. Glutamic
and pyruvic transaminases were within nor mal values. A skin biopsy from the left paranasal
region showed a severe chronic granulomatous
giant cell reaction in the upper and mid dermis,
with the presence of many large non-septate hyphae,
surrounded by granular eosinophilic mate
rial (so-called Splendore-Hoeppli reaction) (Fig.
4). Once the diagnosis of entomophthoromycosis was made by tissue section, a second biopsy from
the skin of the glabellar nodule was obtained for
cultures. The fresh material was inoculated onto
tubes with Sabouraud's dextrose-agar and incu
bated at room temperature. Growth became vis
ible after 48 hours; by 72 hours the colonies were very prominent, with a radiating furrow pattern.
The sides of the tubes were soon covered by co
nidia which had been discharged from their co- nidiophores (Fig. 5). Microscopically, the fungus
corresponded to Conidiobolus coronatus, as
shown in Figures 6 and 7. The conidia were very
large, globose and multinucleated. No zygospores were present. The conidia were borne on erect
conidiophores from which they were forcibly dis
charged. Some underwent multiple replication