Macrophomina phaseolina is an opportunistic fungal pathogen that is prevalent in tropical and subtropical soil. While M phaseolina is a well-known plant pathogen, human infection with M phaseolina is exceedingly rare, with only 4 case reports reported worldwide. It is thought that human infection is acquired from environmental exposure to contaminated soil or inhalation of aerosolized conidia.

The most common presentation of M phaseolina infection, in 3 of the 4 patients, was a soft tissue infection. One patient presented with a painful, edematous toe with purulent discharge, another with an ulcerated soft tissue mass on the foot, and the third with a tender, erythematous nodule above the ankle that later ulcerated and became necrotic. The fourth patient experienced traumatic inoculation of the eye with M phaseolina leading to fungal keratitis in an immunocompetent patient, which presented as ocular pain and decreased visual acuity with periorbital edema, conjunctival congestion, corneal epithelial defects, and hypopyon.

Three of the four patients who acquired the infection were immunocompromised, with underlying conditions such as diabetes, solid organ transplant, and malignancy. Three cases occurred in individuals of Asian ethnicity (Indian-American, Indian, and Sri-Lankan Canadian), and 2 patients affected had recently traveled to India.

There have been no reported cases of disseminated M phaseolina infection.