Challenge of Ziehl-Neelsen stain for Basidiobolomycosis diagnosis in Indonesia: A unique case report

Metta Octora; Arthur Pohan Kawilarang; Pepy Dwi Endraswari

doi:10.1016/j.amsu.2022.103278

Challenge of Ziehl-Neelsen stain for Basidiobolomycosis diagnosis in Indonesia: A unique case report

Ann Med Surg (Lond). 2022 Jan 25:74:103278. doi: 10.1016/j.amsu.2022.103278. eCollection 2022 Feb.

Authors

Metta Octora^{1

2}, Arthur Pohan Kawilarang³, Pepy Dwi Endraswari³

Affiliations

¹ Study Program of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
² Faculty of Medicine, Universitas Mataram, Mataram, Indonesia.
³ Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Abstract

Background: Basidiobolomycosis is a rare fungal infection in Indonesia, so alternative investigations are needed to make a diagnosis.

Case presentation: A 24-year-old male patient, Javanese, presented with Basidiobolomycosis. The patient had a lump on the right arm and face 2 years ago, and the tumor progressively grew up and extended to the right upper arm, neck, and face since 1 month ago. This paper discussed the challenge of Ziehl-Neelsen (ZN) stain as a diagnostic tool for Basidiobolomycosis that is a rare case in the world, especially in Indonesia.

Discussion: Acid-fast stain has never been used to diagnose fungal cases in general, but it could describe the hyphae and Splendore-Hoeppli very clearly compared to the standard hematoxylin and eosin (HE) stains.

Conclusion: ZN can be used as an alternative diagnosis of Basidiobolomycosis in a low-resource setting.

Keywords: Acid-fast stain; Basidiobolomycosis; Splendore Hoeppli phenomenon.

Publication types

Case Reports