Subcutaneous Zygomycosis Caused by Basidiobolus Haptosporus: Presentation of a Case Mimicking Burkitt's Lymphoma *

Human Fungal Pathogens of Mucorales and Entomophthorales

“…Some of the clinical symptoms related to B. ranarum intestinal infection previously reported by others include (1) epigastric abdominal pain; (2) low fever; (3) bloody mucous diarrhea; and (4) the presence of tumor-like masses in the stomach and intestinal tissues and sporadic involvement of the regional lymph nodes, liver, and pancreas (Onuigbo and Gugnani 1976;de Aguiar et al 1980;Pasha et al 1997). Intestinal basidiobolomycosis could mimic inflammatory bowel disease, colon carcinoma, Crohn's disease, and intestinal mucormycosis (Onuigbo and Gugnani 1976;Bittencourt et al 1982;Pasha et al 1997;Gugnani 1999;Hassan et al 2013). In addition, unusual cases of B. ranarum affecting lungs (Bittencourt et al 1980), lymph nodes (Kamalam and Thambiah 1979), maxillary sinus and palate (Dworzack et al 1978), and muscles (Kamalam and Thambiah 1982) have been also recorded.…”

“…Remarkably, the patients did not have fever or pain, and their general conditions were considered good. These cases can be used to illustrate the typical clinical features encountered in most subcutaneous basidiobolomycosis cases, with the enlargement of regional lymph nodes sometimes mimicking Burkitt's lymphoma (Bittencourt et al 1982). The anatomical distribution of the lesions includes upper and lower limbs, thorax, and abdomen, and more rarely the neck, trunk, and face (Koshi et al 1972;Gugnani 1999).…”

Zygomycetes in Human Disease

“…This lack of virulence is also suggested by experiments in mice. Following experimental inoculation of Basidiobolus in mice, invasive disease was not seen (42). It has been suggested that some unknown abnormality must account for the disease (442) and that invasive and progressive infection in previously healthy individuals may result from transient immunosuppression during viral infections or following surgery (441).…”

“…The definitive diagnosis of basidiobolomycosis requires an excellent physical examination together with both pathologic and microbiologic evaluation, since basidiobolomycosis may resemble other infections, especially other tropical infections, which present with subcutaneous lesions (442). Basidiobolus infection may resemble other fungal infections (pythiosis and sporotrichosis), parasitic infections (filarial elephantiasis and onchocerciasis), bacterial infections (Mycobacterium tuberculosis and M. ulcerans) (442), and other diseases, including Burkitt's lymphoma (42). While the direct examination may suggest the diagnosis, culture remains the "gold standard" for diagnosis.…”

“…Pharmaceutical agents that have been used to successfully treat Basidiobolus infection include most commonly potassium iodide (KI) (42,228,384,480), trimethoprim-sulfamethoxazole (384), amphotericin B (133), oral azoles (109,131,359) and KI combined with oral azoles (44). Treatment of Basidiobolus is not always successful, and no single drug has proved effective in the treatment of all cases of basidiobolomycosis (320, 384).…”