An instance of excellent response of subcutaneous zygomycosis to itraconazole monotherapy

Abstract

Subcutaneous zygomycosis is a rare fungal infection caused by Basidiobolus ranarum . This entity is usually endemic in South India and only limited numbers of cases have been reported from central India. We report a case of 4-year-old male child from Chhattisgarh, who presented with a painless, non-tender, large, subcutaneous swelling of 4 months duration on the right upper arm, which was initially misdiagnosed as benign spindle cell tumor and advised surgical resection. But the fungal culture of the affected tissue grown Basidiobolus ranarum and the child responded very well to itraconazole therapy only.

Identification of Basidiobolus species from the common house gecko (Hemidactylus frenatus) and their association with isolates from human basidiobolomycosis

“…Similarly, antigenic analysis, isoenzyme banding and restriction enzyme analysis show that all human pathogens belong to B. ranarum. In two studies, B. ranarum was isolated in South India (Khan et al, 2001;Patro et al, 2019). Many articles have specified that the house gecko had a role in the epidemiology of salmonellosis and had an impact on public health (Jimenez et al, 2015).…”

Basidiobolomycosis

“…This case report highlights the importance of high index of suspicion required to diagnose the condition in nonendemic areas and early diagnosis of this clinical entity to prevent unnecessary surgical intervention, disfigurement produced by advanced disease, and unnecessary psychological trauma to the patient. 23 …”

An unusual presentation of unilateral lower limb gigantism in a case of subcutaneous entomophthoromycosis

“…Acquired causes of limb gigantism in adults includes filarial elephantiasis, onchocerciasis, diffuse large B-cell lymphoma (leg type), and soft tissue sarcoma. 1 We present a case of subcutaneous entomophthoromycosis manifesting as unilateral gigantism of lower limb.…”

“…4 The sites of involvement in descending order of frequency are gluteal region, thigh, anterior abdominal wall, chest, and back, in the "bathing suit" distribution. 1,5 It presents as firm, painless erythematous plaques or disc-shaped rubbery mobile masses easily lifted from deeper tissues (doughnut lifting sign). The presentation of basidiobolomycosis as diffuse swelling of an entire limb resembling gigantism is a relatively rare one, with only a few reports in literature.…”

“…Elephantiasis due to lymphatic filariasis is another acquired cause of a progressive enlargement of limb; however, it is preceded by fever, chills, lymphadenitis, and starts with pitting edema of the feet, progressing proximally. 1,4 The typical histopathological feature of basidiobolomycosis is the presence of thin-walled broad aseptate hyphae with an eosinophilic sheath, frequently phagocytized within giant cells.…”