Subcutaneous basidiobolomycosis: An unusual fungus in immuno-competent children, vindicating longer duration of anti-fungal treatment

Subcutaneous Basidiobolomycosis is a rare fungal infection caused by environmental saprophyte Basidiobolus ranarum. The disease is seen among immunocompetent individuals of age 18 months to 80 years, being more common in children. We report a case of Subcutaneous Basidiobolomycosis in a 10-year-old immunocompetent male child from Ahmednagar, Maharashtra who presented with complaints of right gluteal non tender, diffuse swelling, which was gradually progressive involving inner and back of thigh. The overlying skin was hyperpigmented with scaling at places. It was associated with complaints of difficulty in walking and voiding of urine. Patient was prescribed multiple medicines with no records available. All primary investigations were done along with a deep incisional biopsy for histopathology. MRI was suggestive of? lymphangioma? vascular malformation. Histopathology revealed panniculitis with dense collections of eosinophils. Few broad, aseptate fungal hyphae were seen camouflaged within the inflammatory infiltrate, surrounded by Splendore-Hoeppli phenomenon. The patient was treated with oral fluconazole for a period of one year with complete resolution of the symptoms. After one year of follow-up, the patient is clinically well. Clinically, this lesion presented as induration of skin and subcutaneous tissue thus mimicking a soft tissue sarcoma. However, histopathological examination clinched the diagnosis. Fungal infections are common in immuno-suppressed patients, and extremely uncommon in children. Since this is an exceptional rare fungal infection seen in immuno-competent children and young adults, it is often disregarded as a differential diagnosis.