title: Gastrointestinal basidiobolomycosis in a child; an unusual fungal infection mimicking fistulising Crohn's disease.
abstract: BACKGROUND
  Gastrointestinal basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. It has been reported in both children and adults. The disease mainly affects the colon and the small bowel; however, cases of the stomach, liver, pancreas, and renal system being affected have been reported.
  
  
  METHODS
  A 2 year old boy presented with the following symptoms; abdominal pain, vomiting, diarrhea, fever and palpable right iliac fossa mass. Laboratory investigations revealed elevated inflammatory markers and peripheral eosinophilia. Colonoscopy showed severely inflamed mucosa of the terminal ileum, cecum and ascending colon. CT scan of the abdomen demonstrated an inflammatory mass with wall thickening of the terminal ileum and the colon. Surgical exploration demonstrated retroperitoneal mass and inflamed terminal ileum, cecum and ascending colon. Upon laparotomy, multiple internal fistulas involving the bowel loops, the urinary bladder, the right ureter and the gallbladder were observed. Further investigations using histopathology of the resected diseased bowel showed extensive necrosis, multinucleated giant cells and numerous eosinophils and large fungal hyphae surrounded by strongly eosinophilic material were seen in the tissue suggestive of B. ranarum infection. The patient responded well to treatment with voriconazole.
  
  
  CONCLUSIONS
  Gastrointestinal basidiobolomycosis should be considered in the differential diagnosis of every child presenting with abdominal pain, fever and palpable abdominal mass with peripheral eosinophilia. The presence of bowel inflammation and fistulas should not preclude such diagnosis.
authors.affiliation: Department of Pediatrics, Faculty of Medicine & King Abdul-Aziz University Hospital, King Abdul-Aziz University, Jeddah, Saudi Arabia. saadaho@hotmail.com
authors.forename: Omar I
authors.initials: OI
authors.lastname: Saadah
authors.forename: Mohammad F
authors.initials: MF
authors.lastname: Farouq
authors.forename: Nawaf Al
authors.initials: NA
authors.lastname: Daajani
authors.forename: Jamal S
authors.initials: JS
authors.lastname: Kamal
authors.forename: Ahmad T
authors.initials: AT
authors.lastname: Ghanem
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003082:Colectomy; D003424:Crohn Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D020091:Entomophthorales; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D008297:Male; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D020096:Zygomycosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole