Entomophthoramycosis of Thigh: A Case Report with Review of Literature

Abstract

Entomophthoramycosis is a sporadic, slow-growing subcutaneous infection that includes two distinct clinical forms: Basidiobolus ranarum (subcutaneous) and Conidiobolus coronatus (Rhinofacial), common in tropical countries like India. A 20-year-old male presented with painless progressive swelling of the anterolateral aspect of the right thigh, with a history of Incision and Drainage (I&D) not responding to antibiotics. A clinical diagnosis of a soft-tissue tumour was made. Magnetic Resonance Imaging (MRI) showed a subcutaneous lesion with inflammatory changes and overlying skin changes. Core biopsy showed spindle cells. Surgeons proceeded with a wide local excision of the lesion. Histopathology {Haematoxylin and eosin (H&E), Grocott Methenamine Silver stain (GMS), Periodic Acid Schiff stain (PAS)} proved to be subcutaneous zygomycosis showing Splendore-Hoeppli phenomenon. The patient was then started on antifungal treatment followed by skin grafting. In the present case, the granulomatous inflammation was not picked up in multiple random core biopsies and hence, a wide excision was done, leading to an avoidable extensive surgery.

Keywords

• histopathology
• subcutaneous
• zygomycoses