title: Gastrointestinal basidiobolomycosis: an emerging fungal infection causing bowel perforation in a child.
abstract: Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal (GI) tract. We report a 10-year-old boy diagnosed as suffering GI basidiobolomycosis after being misdiagnosed first as suffering intestinal malignancy then schistosomiasis. The patient presented with fever, abdominal pain, vomiting, abdominal tenderness and rigidity with marked blood eosinophilia. Abdominal ultrasonographic and computed tomographic scans revealed a large caecal mass. Biopsy of the mass showed transmural granulomatous inflammation interpreted as schistosomal granuloma, ruling out lymphoma. The patient's condition deteriorated despite anti-schistosomal therapy. Emergency surgery was then performed, and caecal perforation was found. The mass was excised; cultures were negative and histopathological examination was suggestive of schistosomal granuloma. The mass recurred 3 weeks post-operatively. Second-opinion histopathological examination diagnosed Basidiobolus ranarum infection. Treatment with itraconazole produced marked improvement, with diminution of the mass. B. ranarum was unequivocally identified in the archival formalin-fixed and paraffin-embedded (FFPE) tissue by PCR. This case emphasizes the need to consider GI basidiobolomycosis in children presenting with fever, abdominal mass and eosinophilia, especially those complicated by bowel perforation.
authors.affiliation: Paediatric Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mortada H F
authors.initials: MHF
authors.lastname: El-Shabrawi
authors.affiliation: Paediatric Department, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.|Paediatric Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Naglaa Mohamed
authors.initials: NM
authors.lastname: Kamal
authors.affiliation: Paediatric Surgery, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Jouini
authors.affiliation: Paediatric Department, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Harbi
authors.affiliation: University of Jena, School of Biology and Pharmacy, Institute of Microbiology, Jena, Germany.|Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology, Jena, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Voigt
authors.affiliation: Quality and Development, Taif University, Taif, Saudi Arabia.|Paediatric Surgery, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
authors.forename: Talal
authors.initials: T
authors.lastname: Al-Malki
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000935:Antifungal Agents / Q000008:administration & dosage; D001706:Biopsy; D002648:Child; D020091:Entomophthorales / Q000302:isolation & purification*; D006651:Histocytochemistry; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D017964:Itraconazole / Q000008:administration & dosage; D008297:Male; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D011860:Radiography, Abdominal; D014056:Tomography, X-Ray; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole