A Case of Subcutaneous and Gastrointestinal Basidiobolomycosis in Singapore

Entomophthoromycosis due to Basidiobolus is a known cause of subcutaneous zygomycosis. It occasionally causes invasive disease involving the gastrointestinal tract. We describe a case of proven subcutaneous entomophthoromycosis, with subsequent development of gastrointestinal basidiobolomycosis, in a 67 year old Singaporean Chinese male. He presented with a progressively enlarging left inguinal mass with intra-abdominal extension, causing compression of the ureters and hydronephroses. He underwent multiple biopsies to ascertain the cause of the mass. Workup for malignancy, bacteria, fungal, parasitic and tuberculous infections were negative.  He developed worsening gastrointestinal distension a year from initial presentation. Imaging showed mucosal thickening extending from the descending colon to the rectum. Based on the clinical presentation, he was treated as for basidiobolomycosis. He responded poorly to treatment and passed away two months after initiation of therapy. With the help of our counterparts in India, we proved our clinical suspicion by polymerase chain reaction on tissue specimen.