Muscle invasion byBasidiobolus haptosporus

Abstract

Invasion of muscle tissue in addition to dermis and subcutaneous tissue by Basidiobolus haptosporus is reported in a 40-year-old female housewife. This infection followed intramuscular injection injury of the right gluteal region. Oral KI cured the condition completely in 6 months. Intramuscular implantation of B. haptosporus by the injection needle is the probable mode of infection in this case. Possible blood vessel invasion seen in histology suggests the possibility of dissemination of the fungus.Basidiobolomycosis and conidiobolomycosis are not uncommon in our state and lymph node invasion has been frequent in most of the cases reported from our department [1-3]. The present is our first case with muscle invasion by Basidiobolus haptosporus and it is the second to have followed a penetrating wound by an injection needle. CASE REPORTA 40-year-old housewife was referred by a surgeon for a skin lesion which had started as a small asymptomatic nodule over the right gluteal area, within a few weeks of an intramuscular injection at that site for myalgia, and had spread intensively over a period of 6 months. She showed an extensive hyperpigmented, oedematous, well defined plaque with peau d'orange surface skin involving the right gluteal, the iliac, the lower half of the abdominal wall, the pubis, the upper quarter of the anterior aspect of the right thigh and the right labium majora (Fig. 1). The entire plaque was continuous and did not cross the midline either anteriorly or posteriorly. It felt Indiarubber-like or hard and was painful but not tender. The right iliac portion of the plaque was prominent and hanging over the inguinal crease. Due to enormous thickening of the skin it was not possible to palpate the right inguinal or iliac lymph nodes. Her left inguinal lymph nodes were normal. A possible carcinoma cervix and secondary cutaneous deposits had been excluded by the surgeon previously.

Zygomycetes in Human Disease

“…Three of the five infected patients died due to progression and obstruction. Basidiobolus has also been identified in patients with lymph node (224,225,228) and muscle (227,228) involvement. Other reports of invasive disease with B. ranarum include a case of invasive retroperitoneal infection in an 8-year-old boy (320) and a patient with locally aggressive disease originating in the maxillary sinuses causing ulcerations in the hard palate (133).…”

“…In addition to subcutaneous infection, basidiobolomycosis has expanded to involve other tissues including the gastrointestinal tract, lymph nodes, and muscles (41,110,225,228,320,359). Angioinvasive disease has also been seen in one culture-confirmed case (228).…”

“…While inhalation of spores may also play a role for disease transmission with Conidiobolus, intranasal trauma such as is seen with nose picking also probably contributes to the development of disease (184). Disseminated disease is uncommonly described with the Entomophthorales (63,136,228,451,486,487).…”

“…Infections involving additional body sites are cited in the literature, but these lack culture confirmation and should be classified as "zygomycosis" instead of basidiobolomycosis. Likewise, vessel invasion by this organism has been clearly identified in only one case (228). Additional cases credited with blood vessel invasion are based on tissue diagnosis alone and lack culture confirmation (273,451).…”

Gastrointestinal basidiobolomycosis in children: an overlooked emerging infection?

“…Iatrogenic infection has been reported. Nazir et al (1997) reported a case of possible inoculation during appendectomy, and Kamalam & Thambiah (1984) reported inoculation from a needle injection. B. ranarum typically causes a chronic infection of the peripheral or subcutaneous tissue, usually on the arms, trunk and buttocks (Goodman & Rinaldi, 1991).…”