Subcutaneous Zygomycosis Due to Basidiobolus ranarum: A Case Report from Maharastra, India

Entomophthoromycosis is a rare entity. We hereby report a case of entomophthoromycosis in a three-year-old Asian child who presented with a painless, nontender, rapidly increasing large swelling on the thigh of six months duration, which was initially misdiagnosed as a soft tissue tumor and resected. The cause of misleading diagnosis was rapid growth of the lesion in a short duration of time, indicating the possibility of a tumor. Histopathological examination revealed an inflammatory lesion with aseptate fungal hyphae and the characteristic Splendore-Hoeppli phenomenon. Microbiological examination identified the fungus as Basidiobolus ranarum. Complete excision of the lesion followed by antifungal therapy was associated with complete recovery. Entomophthoromycosis should be considered early when children from endemic areas present with unusual, rapid-growing lesions of the subcutaneous region. In order to emphasize tumor-like presentation of zygomycosis, we are presenting this case. 1. Introduction Entomophthoromycosis (subcutaneous zygomycosis) is a sporadic subcutaneous infection that is largely restricted to tropical areas of Africa, Asia, and South America. It presents in two clinically distinct forms. Subcutaneous zygomycosis, caused by Basidiobolus ranarum and rhinofacial zygomycosis caused by Conidiobolus coronatus. Neither of these two forms occur preferentially in patients with underlying disease or defective immunity [1]. Entomophthoromycosis is characterized by the formation of firm and nontender swellings, generally on the extremities, trunk, and rarely other parts of the body [2]. Subcutaneous zygomycosis can also mimic soft tissue tumors [3]. We present a case of a 3-year-old Asian boy with a large, rapid-growing zygomycotic lesion of the left thigh which was initially misdiagnosed as a soft tissue tumor, emphasizing the importance of rapid and thorough diagnosis with a high index of suspicion, especially in endemic areas. 2. Case Presentation A three-year-old male child was admitted with the complains of a gradually increasing painless swelling over the left thigh of 6 months duration. There was a history of trauma to the site three months prior to the onset of the present swelling. Local examination showed a 14 × 8？cm nontender indurated subcutaneous swelling on the left thigh over the anterolateral, medial, and posterior aspect. The swelling was firm in consistency with smooth and rounded edges and was freely mobile over the underlying structures. The overlying skin was lobulated and hyperpigmented and showed a 2？cm linear scar. There