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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

Summary

A 46-year-old man developed a severe thigh infection caused by a rare fungus called Basidiobolus ranarum, which started from an insect bite two years earlier. The infection became life-threatening when bacteria also invaded the area, causing widespread tissue death and eventually requiring amputation of the leg. Treatment required a combination of multiple antifungal medications, antibiotics, and repeated surgical cleanings. After aggressive multi-pronged therapy including oral potassium iodide and three months of antifungal pills, the remaining wound healed completely.

Background

Basidiobolomycosis is a rare fungal infection typically transmitted through insect bites or direct inoculation by trauma in immunocompetent hosts. Deep tissue colonization with secondary bacterial infection is uncommon and presents significant treatment challenges, particularly in patients from rural areas with delayed medical care.

Objective

To report a rare case of invasive necrotizing myositis of the thigh caused by Basidiobolus ranarum complicated by polybacterial sepsis and to describe the multi-pronged therapeutic approach required for successful management.

Results

Basidiobolus ranarum was identified through morphological and cultural characteristics showing broad aseptate hyphae, zygospores with beak-like appendages, and ballistospores. The patient was treated with amphotericin B initially, followed by voriconazole combined with oral Lugol’s iodine, antibiotics, and multiple debridements, ultimately requiring trans-femoral amputation. Subsequent oral itraconazole for three months resulted in complete wound healing.

Conclusion

Early recognition of fungal infection through KOH microscopy and prompt initiation of antifungal therapy combined with surgical intervention is critical. A multi-pronged approach including dual systemic antifungals, antibiotics, and surgery successfully managed this near-fatal infection, though earlier medical intervention would have preserved the limb.
  • Published in:Current Medical Mycology,
  • Study Type:Case Report,
  • Source: PMID: 41122114, DOI: 10.22034/cmm.2025.345248.1614
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