# A rare case of invasive necrotizing myositis of the thigh caused by Basidiobolus ranarum: a multi-pronged approach to successfully managing a near-fatal polybacterial mycotic infection

## TL;DR

A rare case of severe thigh infection caused by a fungus is successfully treated using a multi-step approach in an immunocompetent man.

## Contribution

A successful multi-pronged treatment strategy for a rare and near-fatal fungal infection is described.

## Key findings

- Basidiobolus ranarum was identified through culture, microscopy, and histopathology.
- The infection was complicated by secondary bacterial sepsis and showed resistance to monotherapy.
- Prompt antifungal treatment based on KOH preparation findings was critical for diagnosis and management.

## Abstract

Traumatic fungal diseases are relatively less common and present significant challenges in treatment. In some cases, there is progressive spread and deep soft tissue colonization, especially in immunocompromised patients and those showing neglect and non-compliance with treatment. This pattern is common in patients from rural settings who are unaware of the consequences of delaying medical care and the resulting complications.

This study reported a case of Basidiobolomycosis manifesting as deep necrotizing myositis of the left thigh complicated by secondary bacterial sepsis in a 46-year-old immunocompetent man. Basidiobolus ranarum, was morphologically identified, isolated in culture and supported by wet mount microscopy and histopathology. It was treated with a multipronged strategy due to a refractory infection showing an unsatisfactory response to fungal monotherapy.

The diagnosis was evasive due to the clinical picture of overt soft-tissue necrosis resembling a highly virulent bacterial infection showing antibiotic resistance. Broad aseptate hyphae in potassium hydroxide mount (KOH 10%) preparation led us to suspect the Entomophthorales organism and initiate prompt antifungal chemotherapy.