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

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.