Paediatric case of gastrointestinal basidiobolomycosis mimicking appendicitis – Case report

• Published in: International journal of surgery case reports 2019-01, Vol.63, p.80-84
• Main Authors: Arabi, Rami Issam, Aljudaibi, Abdullah, Shafei, Bashaer Ahmed, AlKholi, Hatoon Mohammed, Salem, Maged Ezzat, Eibani, Khalid Ali
• Format: Article
• Language: English
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2019.09.001

•Basidiobolomycosis is a rare fungal infection that leads to subcutaneous infection.•Gastrointestinal basidiobolomycosis is difficult to diagnose primarily due to its non-specific clinical presentation.•Gastrointestinal basidiobolomycosis should be a differential especially in paediatric patients present with abdominal mass and eosinophilia.•Optimal way to manage gastrointestinal basidiobolomycosis is by surgical resection followed by 3 months of antifungal treatment. Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum that normally leads to subcutaneous infection and, rarely, to involvement in the gastrointestinal tract. A 6-year-old boy presented to the Emergency department (ED) complaining of abdominal pain of a few weeks’ duration in the right lower quadrant, associated with fever and vomiting. A computed tomography (CT) of the abdomen was done. It showed an enlarged tubular structure in the right iliac fossa, a suspected appendicular lesion, and free fluid collection, as well as multiple enlarged mesenteric and right iliac lymph nodes. Based on these results, the decision was made to do surgical exploration on the patient. After two weeks, the patient developed tachycardia, abdominal distention, constipation, and spikes of fever. Two days later, re-exploration was performed. An ileostomy and colostomy were performed and drains inserted. Post-operative, the patient was pushed to paediatric intensive care unit (PICU), while still intubated and hemodynamically stable. However, he developed cardiac arrest on the same day and cardiopulmonary resuscitation (CPR) was performed, but he couldn't be resuscitated. The patient presented with severe abdominal pain in the right lower quadrant, as well as fever and vomiting. These complaints may have been misdiagnosed as appendicitis. The diagnosis of gastrointestinal basidiobolomycosis was confirmed by histopathology, based on a surgical specimen taken during the primary exploration. The management was a combination between surgical intervention and medical treatment.