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The last few boss fights have the players fighting gargantuan opponents (the boneyard of Kyuss, brazzemal and dragotha,) and I had a sudden image that when Kyuss emerges from the monolith he's a medium creature instead of a huge one. I imagine this making the fight at the end more vivid, since instead of dodging attacks from a giant the players are able to duel him. I think I'd keep the stats the same (even ac, weapon damage and attack bonus) except for reach. The only thing I think this might effect is that it would be easier to get into melee against him, since he wouldn't be able to use engulf as an attack of opportunity. I'd keep engulf working on large or smaller creatures. Bull rushes and other abilities based on size will become more effective. Is there anything I'm missing?
I'd still give him the reach and the engulf, just reskin it.
Make the worms shoot forth in a stream like Venom for the reach and the engulf could be the worms quickly reproducing to envelope the person.