Visceral basidiobolomycosis: An overlooked infection in immunocompetent children

Abstract

Visceral basidiobolomycosis is an unusual fungal infection of viscera caused by saprophyte Basidiobolus ranarum. It is very rare in healthy children and poses a diagnostic challenge due to the non-specific clinical presentation and the absence of predisposing factors. We report a case of gastrointestinal basidiobolomycosis in a 4-year-old healthy girl who presented with a short history of abdominal pain, bleeding per rectum, fever, and weight loss. The diagnosis was based on high eosinophilic count, classical histopathology findings of fungal hyphae (the Splendore-Hoeppli phenomenon), and positive fungal culture from a tissue biopsy. Fungal infection was successfully eradicated with a combined approach of surgical resection of the infected tissue and a well-monitored course of antifungal therapy. The atypical clinical presentation, diagnostic techniques, and the role of surgery in the management of a rare and lethal fungal disease in an immunocompetent child are discussed.

Figure 1

MRI before surgical intervention and antifungal treatment: T2 weighted axial cross (A) and Sagittal (B) sections showing a large retrocolic heterogenous mass predominantly hypointense, indiscernible from the descending colon, with surrounding high signal in the retroperitoneal fat

Figure 2

Operative findings showing oedematous left colon surrounded by an inflammatory mass containing microabscesses

Figure 3

H and E (a) And Gomori's methenamine silver staining (b) Of the tissue biopsy from left retrocolic mass showing the presence of Splendore-Hoeppli bodies and many eosinophils, as well as intensely radiating eosinophilic granular material, surrounding the fungal elements ([a] ×20 and [b] ×40)