(Last Updated On: March 18, 2021)

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

1.Gugnani HC. A review of zygomycosis due to Basidiobolus ranarum. Eur J pidemiol. 1999; 15: 923-929.

2. Sujatha S, Sheeladevi C, Khyriem AB, Parija SC, Thappa DM. Subcutaneous zygomycosis caused by Basidiobolus ranarum—a case report. Indian J Med Microbiol. 2003; 21(3): 205–206.

3. Anand M, Deshmukh SD, Pande DP, Naik S, Ghadage DP. Subcutaneous zygomycosis due to Basidiobolus ranarum: a case report from Maharastra, India. J Trop Med. 2010; 2010: Article ID 950390, 3 pages. doi: 10.1155/2010/950390.

4. Mondal AK, Saha A, Seth J, Mukherjee S. Subcutaneous zygomycosis: a report of one case responding excellently to potassium iodide. Indian J Dermatol. 2015; 60(5): 500–502.

5. Kamalam A, Thambiah AS. Muscle invasion by Basidiobolus haptosporus following IM injection. Sabouraudia. 1984; 22: 273-277.

6. Department of Health, Republic of the Philippines [Internet]. National Tuberculosis Control Program; c2020 [cited on 2020 April 27]. Available from: http://www.ntp.doh.gov.ph/magnitudeTB.php

7. Department of Health, Republic of the Philippines [Internet]. National Leprosy Control Program; [cited on 2020 April 27]. Available from: http:// www.doh.gov.ph/leprosy-control-program

8. Leru PM. Eosinophilic disorders: evaluation of current classification and diagnostic criteria, proposal of a practical diagnostic algorithm. Clin Transl Allergy. 2019; 9: 36.

9. Anaparthy UR, Deepika G. A case of subcutaneous zygomycosis. Indian Dermatol Online J. 2014; 5 (1): 51-41.
10. El-Shabrawi MHF, Arnaout H, Madkour L, Kamal NM.
Entomophthoromycosis: a challenging emerging disease. Mycoses. 2014;57 (3): 132–137.

11. Davis SR, Ellis DH, Goldwater P, Dimitriou S, Byard R. First human cultureproven australian case of entomophthoromycosis caused by Basidiobolus ranarum. J Mycol Med. 1994; 32 (3): 225–230.

12. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000; 13: 236.

13. Haque A. Special stains use in fungal infections. Connection. 2010; 187- 194.

14. Jayanth ST, Gaikwad P, Promila M, Muthusami JC. The sinus that breeds fungus: subcutaneous zygomycosis caused by Basidiobolus ranarum at the injection site. Case Reports in Infectious Diseases. 2013; 2013: Article ID 534192, 2 pages. doi: 10.1155/2013/534192

15. Mathew R, Kumaravel S, Kuruvilla S, Varghese RG, Shashikala, Srinivasan S, Mani MZ. Successful treatment of extensive basidiobolomycosis with oral itraconazole in a child. Int J Dermatol. 2005; 44 (7): 572–575.

16. Verma RK, Shivaprakash MR, Shanker A, Panda NK. Subcutaneous zygomycosis of the cervicotemporal region: due to Basidiobolus ranaram. Med Mycol Case Rep. 2012; 1(1): 59–62.

17. Goyal A, Gupta N, Das S, Jain S. Basidiobolomycosis of the nose and face: a case report and a mini-review of unusual cases of basidiobolomycosis. Mycopathologia. 2010; 170:165–168.

18. Ostrosky-Zeichner L, Smith M, Michael R. McGinnis. Zygomycosis. In: Anaissie EJ, McGinnis MR, Pfaller MA, eds. Clinical Mycology 2nd edition. London, United Kingdom: Churchill Livingstone; 2009: 305.

19. Thotan SP, Kumar V, Gupta A, Mallya A, Rao S. Subcutaneous phycomycosisfungal infection mimicking a soft tissue tumor: a case report and review of literature. J Trop Pediatr. 2009; 56(1): 65–66.

20. Patro P, Das P, Sachdev D, Borkar N, Ganguly S, Hussain N. An instance of excellent response of subcutaneous zygomycosis to itraconazole monotherapy. Med Mycol Case Rep. 2019; 24: 13–17.

21. Sackey A, Ghartey N, Gyasi R. Subcutaneous basidiobolomycosis: a case report. Ghana Med J. 2017; 51(1): 43-46.

22. Mahamaytakit N, Singalavanija S, Limpongsanurak W. Subcutaneous zygomycosis in children: 2 case reports. J Med Assoc Thai. 2014; 97 (6): 248-253.

23. Kumaravel S, Bharath K, Rajesh NG, Singh R, Kar R. Delay and misdiagnosis of basidiobolomycosis in tropical South India: case series and review of the literature. J Paediatr Child Health. 2016; 36 (1): 52-57.

24. Brun LVC, Roux JJ, Sopoh GE, Aguiar J, Eddyani M, et al. Subcutaneous granulomatous inflammation due to Basidiobolomycosis: case reports of 3 patients in buruli ulcer endemic areas in Benin. Case Rep Pathol. 2018;

25. Gupta AK, Cooper EA, Ginter G. Efficacy and safety of itraconazole use in children. Dermatol Clin. 2003; 21: 521–535

26. Tucker RM, Haq Y, Denning DW, Stevens DA. Adverse events associated with itraconazole in 189 patients on chronic therapy. J Antimicrob
Chemother. 1990; 26: 561–566.

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