Subcutaneous Basidiobolomycosis Resembling Fournier's Gangrene

Basidiobolomycosis: Case Report and Literature Overview

Basidiobolomycosis or subcutaneous zygomycosis or subcutaneous phycomycosis is a chronic granulomatous infection of skin and subcutaneous tissue, caused by a saprophytic filamentous fungus, Basidiobolus ranarum, clinically characterized by firm, painless subcutaneous swelling with smooth and rounded edges. Histopathological features include the peculiar Splendore–Hoeppli phenomenon. Culture on Sabouraud dextrose agar shows creamy white, heaped up, and furrowed colonies. This entity has been reported from tropical and subtropical regions of the world and the southern part of India. We report a case of Basidiobolomycosis in a seven-year-old girl from Eastern India, which was excised twice before presenting to us. We diagnosed the case as Basidiobolomycosis based on clinical features, histopathology, and culture findings, and treated it with itraconazole.

Disseminated and ulcerative basidiobolomycosis simulating a Buruli ulcer in an immunocompetent girl in Southern Benin

Basidiobolomycosis is a subcutaneous mycosis, for which non-specific clinical presentation can be a source of diagnostic wandering. A 5-year-old girl was brought for consultation with chronic ulcers of the pelvic limbs evolving for 8 months. The lesions started when the girl was 18 months old with a painless, pruritic nodule of the right buttock, indurated placard following progressive extension to the pelvic limbs, back and abdomen, and secondarily ulcerated in several places. On examination, there was an alteration of the general condition, a large, indurated and erythematous plaque, with sharp edges. On this plaque, there were nodular lesions and necrotic ulcers, with detached margins. The left knee was blocked in flexion. Ziehl staining and polymerase chain reaction for Mycobacterium ulcerans were negative. The histopathological picture was suggestive of basidiobolomycosis. The evolution was favorable after giving her ketoconazole (100mg per day) for 14 weeks associated with surgery and physiotherapy. This clinical case confirms the difficulties in diagnosing basidiobolomycosis, especially in endemic areas of Buruli ulcer.