Basidiobolomycosis: Case series.
BACKGROUND
Basidiobolus ranarum is a fungus found in the dung of amphibians, reptiles and insectivorous bats. Basidiobolomycosis is a chronic subcutaneous infection of the trunk and limbs caused by B. ranarum. The disease is a well-known infection in the tropical areas. It usually presents with subcutaneous or gastrointestinal lesions and rarely with systemic affection. Recently, the etiologic role of B. ranarum in the gastrointestinal infections has been increasingly recognized.


METHODS
Here, we retrospectively reviewed the records of five patients with basidiobolomycosis, all from the same geographic region (Tohama area, Aseer province, southern region of the Kingdom of Saudi Arabia).


RESULTS
All the cases presented with prolonged fever and other manifestations suggestive of either chronic infection (such as tuberculosis) or malignancies (such as lymphoma). The diagnosis of gastrointestinal basidiobolomycosis was established on histolological ground (granulomatous reaction, dense infiltrate of eosinophils and fungal structures). One case was diagnosed based on the histological features combined with positive tissue culture for B. ranarum. One case was treated by surgical resection of fungal masses (Case I), followed by itraconazole and amphoterecin-B therapy. The other four cases had non-resectable fungal masses and they responded very well for antifungal therapy (cases II, III, and IV received amphotericin-B and itraconazole and case V received amphotericin-B and voriconazole).


CONCLUSIONS
Our study raises several notions. Gastrointestinal basidiobolomycosis is often misdiagnosed as cancer (lymphoma or carcinoma), tuberculosis or inflammatory bowel disease. Its recognition needs high index of suspicion and increased awareness especially in patients with chest, abdominal or neck masses and eosinophilia. The diagnosis of basidiobolomycosis can be established on histological basis in most cases. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features of this condition. There are no prominent risk factors. Usually, surgery and prolonged antifungal therapy are required.
Department of Pediatrics, Aseer Central Hospital, P.O. Box 34, Abha, Saudi Arabia.
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Al Jarie
Department of Internal Medicine, Aseer Central Hospital, Abha, Saudi Arabia; College of Medicine, King Khalid University, Abha, Saudi Arabia.
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Al Azraki
Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Al Mohsen
Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Al Jumaah
College of Medicine, King Khalid University, Abha, Saudi Arabia; Department of Pathology, Aseer Central Hospital, Abha, Saudi Arabia.
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Almutawa
Department of Radiology, Aseer Central Hospital, Abha, Saudi Arabia.
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Mohd Fahim
Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Al Shehri
Department of Pediatrics, Aseer Central Hospital, P.O. Box 34, Abha, Saudi Arabia.
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Abu Dayah
Department of Pediatric Surgery, Aseer Central Hospital, Abha, Saudi Arabia.
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Ibrahim
Department of Child Health, College of Medicine and Medical Sciences, King Khalid University, Abha, Saudi Arabia.
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Maw Shabana
Department of Pathology, Aseer Central Hospital, Abha, Saudi Arabia.
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Rezk Abd-Elwahed Hussein