Gastrointestinal basidiobolomycosis: Beware of the great masquerade a case report

Abstract

Basidiobolomycosis is rare infection caused by the saprophytic fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis is an infrequent, albeit, increasingly reported, emerging form of the disease and typically affects immunocompetent individuals with potentially grave sequelae if unrecognized. Acquaintance with this exceptionally rare fungus and its potential for presenting as gastrointestinal mass masquerading as colonic malignancy is critical for timely diagnosis, appropriate treatment and successful clinical outcome. We report a case of gastrointestinal basidiobolomycosis masquerading as colonic malignancy in a 29-year-old Omani patient successfully treated with combination of surgery and prolonged azole antifungal therapy.

Keywords: Abdominal mass; Gastrointestinal basidiobolomycosis; Itraconazole; Oman; Voriconazole.

Fig. 1

Contrast-enhanced computed tomography (CECT) of the abdomen. A complex mass in the right iliac fossa involving the ileal loops and looks separate from the ascending colon. It measures 8 cm × 8.4 cm × 6.3 cm.

Fig. 2

(A–D): Histopathologic section of cecum. A: Multiple areas of mucosal ulceration, transmural dense inflammatory infiltrate dominated by eosinophils with multiple micro and macro abscesses with thin walled hyphae surrounded by a bright eosinophilic hyaline material radiating out into the surrounding infiltrate creating the Splendore–Hoeppli phenomena. (H&E x600). B: Coagulative necrosis in the wall of the cecum with fungal hyphae of Basidiobolus with the Splendore–Hoeppli phenomena. (H&E x400). C and D: Numerous broad and thin walled hyphae with occasional septations demonstrated with Periodic Acid Schiff stain (PAS x600) and with Gomorrhi's Methenamine-Silver stain (GMS x 600).