When Infection Masquerades as Malignancy: Fatal Basidiobolomycosis Presenting as Suspected Rhabdomyosarcoma in a Child

Basidiobolomycosis is an uncommon fungal infection caused by Basidiobolus ranarum, primarily impacting immunocompetent children in tropical areas. Its indolent presentation and radiologic mimicking to soft tissue cancers often result in misdiagnosis and delayed antifungal treatment.

We report the case of a 10-year-old child from a remote farming community in Ghana who had a 2-year history of a progressively increasing abdominal wall mass, severe malnutrition, and respiratory distress. The initial computed tomography scan suggested rhabdomyosarcoma. Laboratory tests showed severe anemia, hypoalbuminemia, and marked eosinophilia. Histopathology revealed pronounced granulomatous inflammation characterized by multinucleated giant cells and broad septate fungal hyphae, as evidenced by PAS and Grocott stains, thereby confirming basidiobolomycosis. Sadly, the child's condition deteriorated rapidly, with resultant demise prior to the commencement of antifungal treatment.

Basidiobolomycosis could mimic a pediatric soft tissue sarcoma on imaging, particularly in endemic regions. Early clinical suspicion, early detection of eosinophilia, and timely biopsy are crucial to prevent diagnostic delays and enhance outcomes, particularly in resource-limited healthcare systems.