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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 fungal infection of his thigh caused by Basidiobolus ranarum, a rare fungus found in soil and animal feces. The infection worsened with secondary bacterial contamination, leading to tissue death and eventually requiring amputation. Doctors successfully treated the infection using a combination approach: antifungal medications (voriconazole and potassium iodide), antibiotics, and multiple surgical cleanings, though earlier treatment would have saved his limb.

Background

Basidiobolomycosis is a rare fungal infection typically presenting as subcutaneous lesions in tropical regions. Traumatic fungal diseases present significant treatment challenges, particularly in patients with delayed medical care. This case reports an unprecedented severe necrotizing myositis caused by Basidiobolus ranarum complicated by secondary bacterial sepsis.

Objective

To report a rare case of invasive necrotizing myositis of the thigh caused by Basidiobolus ranarum with polybacterial superinfection and to describe the multi-pronged management approach for this near-fatal infection.

Results

Basidiobolus ranarum was successfully isolated and identified through culture and morphological analysis, showing characteristic broad irregular hyphae with thin walls and rare septa, along with round intercalary zygospores with beak-like appendages. The infection progressed to deep tissue necrosis requiring trans-femoral amputation but responded to a multi-pronged approach using voriconazole, oral Lugol’s iodine, antibiotics, and multiple surgical debridements.

Conclusion

Earlier medical intervention would have prevented amputation, but the multipronged approach combining dual antifungal agents (voriconazole and potassium iodide), targeted antibiotics, and repeated surgery successfully controlled this severe infection. This case highlights the critical importance of suspecting fungal infection when antibiotics fail and the effectiveness of oral potassium iodide in managing invasive Basidiobolomycosis.
  • Published in:Current Medical Mycology,
  • Study Type:Case Report,
  • Source: PMID: 41122114; DOI: 10.22034/cmm.2025.345248.1614
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