Maria Christina Corazon C. Gonzalez, MD, DPDS, Eleanor L. Letran, MD, FPDS
Introduction: Subcutaneous zygomycosis or basidiobolomycosis is caused by a saprophytic fungi Basidiobolus ranarum (B. ranarum). It presents clinically as a slowly growing painless subcutaneous nodule more commonly on the extremity, trunk and rarely on other parts of the body. Mode of infection has not been established but most likely follows traumatic implantation. We report a gradually evolving case of basidiobolomycosis in a 12-year-old immunocompetent Filipino male with no history of trauma who responded dramatically to itraconazole.
Case summary: Subcutaneous zygomycosis is caused by Basidiobolus ranarum (B. ranarum) which is endemic in parts of Africa, India and other parts of Asia. We report an evolving case of a Filipino male child who presented with chronic and persistent subcutaneous nodules and plaques on the left extremity. Dense cell infiltrates consisting of lymphocytes, histiocytes and eosinophils were seen on histology with non-septated hyphal structures on Gomori’s methenamine silver stain. Fungal culture of the lesion yielded B. ranarum. Complete resolution of the lesions were observed after 6 months of itraconazole therapy alone.
Conclusion: This case demonstrated the gradual progression of the disease, and that the lack of a history of trauma does not exclude its diagnosis. Subcutaneous zygomycosis should be highly suspected in chronic painless subcutaneous nodules with swelling, and its early recognition is crucial to prevent progression of the disease. In patients whom an infectious cause is suspected, appropriate cultures, special staining, and sometimes repeat biopsies of new cutaneous lesions may be helpful in determining or ruling out the associated disease. Furthermore, performing PAS stain alone to identify the presence or absence of a fungi is insufficient, rather, additional staining such as GMS should be done to heighten detection of fungal elements.
Keywords: Zygomycosis, Entomophthorales, Basidiobolomycosis, Basidiobolus ranarum, Itraconazole, Pediatric dermatology
Gonzalez, MC, Letran, EL. Subcutaneous zygomycosis due to Basidiobolus ranarum in a Filipino child responding to itraconazole: A case report. J Phil Dermatol Soc 2019, 29(2), 78-82
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