Subcutaneous Zygomycosis Due to Basidiobolus ranarum: A Case Report from Maharastra, India

Abstract

Entomophthoromycosis is a rare entity. We hereby report a case of entomophthoromycosis in a three-year-old Asian child who presented with a painless, nontender, rapidly increasing large swelling on the thigh of six months duration, which was initially misdiagnosed as a soft tissue tumor and resected. The cause of misleading diagnosis was rapid growth of the lesion in a short duration of time, indicating the possibility of a tumor. Histopathological examination revealed an inflammatory lesion with aseptate fungal hyphae and the characteristic Splendore-Hoeppli phenomenon. Microbiological examination identified the fungus as Basidiobolus ranarum. Complete excision of the lesion followed by antifungal therapy was associated with complete recovery. Entomophthoromycosis should be considered early when children from endemic areas present with unusual, rapid-growing lesions of the subcutaneous region. In order to emphasize tumor-like presentation of zygomycosis, we are presenting this case.

Entomophthoromycosis: a challenging emerging disease

“…Systemic dissemination is extremely uncommon; however, widespread fatal dissemination had been reported in a previously healthy woman, with involvement of brain, lung, spleen, stomach, kidney and pancreas . Basidiobolomycosis rarely involves extracutaneous systems.…”

Subcutaneous entomophthoromycosis mimicking soft-tissue sarcoma in children

“…Until recently, terms such as 'zygomycosis' [3,6,22] and 'phycomycosis' [2,4,17] have been used to refer EM. It is because Basidiobolus and Conidiobolus were previously included under the order Entomophthorale which was then a subset of the phylum Zygomycota (Fig.…”

“…Many authors [3,25] believe in direct subcutaneous inoculations through trivial injuries such as abrasions or pricks. Others believe that the fungal spores are primarily inhaled or ingested.…”

“…Despite this omnipresence it is perplexing as to why the clinical infection is rare. Only 300 cases of Basidiobolomycosis [3] and 160 cases of Conidiobolomycosis [24] have been reported worldwide. It is suggested that subclinical exposure to the fungal antigen could have resulted in herd immunity.…”

“…Both of them are saprophytes commonly found in soil and decaying organic wastes. Accidental inoculation by inconspicuous injuries such as thorn pricks, scratches, insect bites and contaminated injection-needles may cause human infections [3]. It was first described from Indonesia in 1956 by Lie Kian Joe who reported 2 children with Basidiobolus infection [4].…”