Subcutaneous Basidiobolomycosis Mimicking Malignancy in an Immunocompetent Child: The Role of Multimodality Imaging and Targeted Biopsy

Basidiobolomycosis is a rare subcutaneous fungal infection in immunocompetent children that frequently mimics inflammatory, vascular, and malignant soft-tissue pathologies on imaging. This is a diagnostically challenging case of a nine-year-old boy presenting with progressive, painless, diffuse subcutaneous swelling involving the right upper limb, chest wall, and neck. Ultrasound, contrast-enhanced magnetic resonance imaging (CE-MRI), and positron emission computed tomography (PET-CT) showed a diffuse, infiltrative soft-tissue lesion with increased metabolic activity, raising suspicion for a lymphoproliferative disorder or a slow-flow vascular malformation. Persistent eosinophilia and lack of response to antibiotics heightened diagnostic uncertainty. Definitive diagnosis was achieved only through ultrasound-guided targeted biopsy from the metabolically active component, which confirmed the diagnosis of subcutaneous basidiobolomycosis subsequently. The patient showed significant clinical improvement following itraconazole therapy. This case underscores basidiobolomycosis as an important radiological masquerader and highlights the pivotal role of multimodality imaging in directing precise biopsy and also in preventing misdiagnosis and unnecessary interventions.