Gastrointestinal basidiobolomycosis: An emerging potentially lethal fungal infection
M Ezzedien Rabie1, Abdulla Saad Al Qahtani1, Salim Jamil2, Nabil Tadros Mikhail3, Ismail El Hakeem1, Abdelellah Hummadi1, Khaled Elsayed Elshaar4, Ibrahim Abdelraheem5, Dib Saudi6
1 Department of Surgery, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia
2 Department of Pathology, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia
3 Department of Pathology, King Fahad Hospital, Jazan, Saudi Arabia; Department of Pathology, Alexandria University, Alexandria, Egypt
4 Department of Surgery, King Fahad Hospital, Jazan, Saudi Arabia
5 Department of Paediatric Surgery, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia; Department of Paediatric Surgery, Al Galaa Teaching Hospital, Cairo, Egypt
6 Department of Gastroenterology, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia
Dr. M Ezzedien Rabie
Department of Surgery, Armed Forces Hospital, Southern Region, P. O. Box 101, Khamis Mushait
Source of Support: None, Conflict of Interest: None
Background: Gastrointestinal basidiobolomycosis (GIB) is a newly emerging rare tropical fungal infection which affects immunocompetent individuals.
Patients and Methods: Our database was reviewed to identify patients with biopsy-proven gastrointestinal basidiobolomycosis.
Results: Six patients were recognized, two females and four males, with a median age of 23.5 years (range 11–70). All patients came from the same region and all had eosinophilia and they were all immunocompetent. The clinical and radiological features simulated colorectal malignancy in four patients, inflammatory bowel disease in one patient, and left iliac fossa mass in another patient. The diagnosis was established after extensive colonic surgery in four patients, after open biopsy in one patient and after ultrasound-guided biopsy in another. All patients received prolonged antifungal treatment. In those who received extensive colonic surgery, one patient died, two patients recovered, and one is still receiving antifungal treatment. Patients in whom the diagnosis was established by biopsy only, one patient recovered while the other is showing steady improvement.
Conclusion: GIB is a potentially lethal fungal infection, which affects immunocompetent individuals in temperate and hot arid regions of the world, including Saudi Arabia, Iraq, Iran, and Arizona desert in the United States. The patient usually presents with features suggestive of colonic malignancy, inflammatory bowel disease, or abdominal mass. Establishing the diagnosis by endoscopic- or radiology-guided biopsy, serological tests, fungal cultures, or molecular techniques enables the institution of antifungal treatment, which may lead to complete cure without surgery. With or without surgery prolonged antifungal therapy is always required.