Gastrointestinal Basidiobolomycosis in pediatric patients

Abstract

Introduction Basidiobolomycosis is a rare fungal disease, lately appearing in the gastrointestinal system of pediatric patients. Their clinical presentation resembles that of lymphoma or granulomatous inflammations. This non-specific presentation makes Gastrointestinal Basidiobolomycosis (GIB) a diagnostic challenge. Methods We are reporting the largest series of pediatric GIB, from Saudi Arabia. 12 patients were diagnosed between January 2012 and December 2019, between the ages of 16 months and 8 years. Results The most common symptoms were fever and abdominal pain. Further examination revealed an abdominal mass. Biopsy of the mass was the mainstay of diagnosis, with histological findings of typical filamentous fungal hyphae and zygospores, surrounded by eosinophils. Conclusion Role of surgery was limited to establishing the diagnosis and dealing with complications. Antifungal medication was the cornerstone of treatment in all our patients. Three of our patients were exceptional with complications such as entero-cutaneal fistula, entero-enteric fistula and short bowel syndrome. These complications have not been previously reported. We have discussed the challenges related to their management. The diagnosis of GIB in pediatric patients with abdominal mass, needs a high index of suspicion. We believe outcome depends on the severity of disease, involvement of surrounding tissues and presence of complications at the time of diagnosis.

Disseminated Basidiobolomycosis Caused by Basidiobolus omanensis in a Child with Acute Lymphoblastic Leukemia (ALL). Case Report and Literature Review

“…The most common route of infection in GIB is through ingestion of food contaminated by the fungus from soil or animal excreta. Ingestion of fungal-infested discharges from reptiles such as lizards (particularly the Gecko) and frogs is thought to be the route of infection in human gastrointestinal basidiobolomycosis (GIB) [ 10 , 11 ].…”

Colonic basidiobolomycosis in a patient with systemic lupus erythematosus (SLE)

“…Considering that in previous case report and review studies patients were mostly children about one to ten years old, so pediatricians might consider it among their differential diagnosis [ 16 – 18 ].…”

A case of basidiobolomycosis mimicking rhabdomyosarcoma: A diagnostic challenge

“…The gold standard diagnosis of basidiobolomycosis is the histopathologic evaluation of the biopsy [1] . The treatment modality mentioned in the literature ranged between medical and surgical intervention [ 15 , 16 ]. It is important to state that the prolonged course of antifungal medication from the -azole family showed complete resolution of infection [ 15 , 17 ] follow-ups without surgical interventions.…”