Successful medical therapy for deeply invasive facial infection due to Pythium insidiosum in a child

Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have be en cured only by radical surgical debridement. A 2-year-old boy developed p eriorbital cellulitis unresponsive to antibiotic and antifungal therapy, Th e cellulitis extended to the nasopharynx, compromising the airway and neces sitating a gastrostomy for feeding. P. insidiosum was isolated from surgica l biopsy specimens of the affected tissue. On the basis of in vitro suscept ibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year c ourse of therapy. Cure of deep P. insidiosum infection is feasible with dru g therapy.