Subcutaneous Zygomycosis Successfully Treated With Itraconazole Monotherapy: A Case Report From Central India

Subcutaneous zygomycosis, also known as basidiobolomycosis, is a rare, chronic fungal infection that predominantly affects immunocompetent individuals in tropical and subtropical regions. The disease often presents as firm, painless, indurated subcutaneous swellings that may mimic malignancy, chronic bacterial infections, tuberculosis, or other deep fungal infections, leading to frequent misdiagnosis and unnecessary surgical interventions. We report the case of a 53-year-old immunocompetent man who presented with gradually enlarging, painless swellings over the right thigh and groin, accompanied by mild intermittent burning and pinprick pain for three months. There was no history of trauma or systemic illness. Examination revealed multiple firm, non-tender, indurated plaques with surface ulceration. Laboratory investigations were unremarkable. Histopathological examination of a wedge biopsy demonstrated dense eosinophilic granulomatous inflammation and broad, yeast-like fungal elements encased within an eosinophilic matrix (Splendore-Hoeppli phenomenon), confirming basidiobolomycosis. Fungal culture identified Basidiobolus ranarum. The patient was treated with suprabioavailable itraconazole at a dose of 65 mg twice daily. Marked clinical improvement was observed within one month, and complete resolution of the lesions occurred by five months, leaving minimal residual hyperpigmentation. No recurrence was noted during follow-up. This case highlights the importance of early biopsy and mycological evaluation in patients with chronic subcutaneous swellings to avoid misdiagnosis and unnecessary surgery. Itraconazole is an effective and well-tolerated therapy for subcutaneous zygomycosis, offering a nonsurgical treatment option. Early recognition and antifungal therapy can ensure excellent outcomes in this elusive infection.