Paediatric case of gastrointestinal basidiobolomycosis mimicking appendicitis – Case report

Rami Issam Arabi,Abdullah Aljudaibi,Bashaer Ahmed Shafei,Hatoon Mohammed Alkholi,Maged Ezzat Salem,Khalid Ali Eibani

doi:10.1016/j.ijscr.2019.09.001

Abstract

IntroductionBasidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum that normally leads to subcutaneous infection and, rarely, to involvement in the gastrointestinal tract. Presentation of caseA 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. DiscussionThe 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.

Highlights

Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum that normally leads to subcutaneous infection and, rarely, to involvement in the gastrointestinal tract
Basidiobolus ranarum (B. ranarum) is a fungus of zygomycetes class found in soil and the lung of reptiles, amphibians, and bats that can be transmitted through traumatic inoculation, which causes basidiobolomycosis, a rare fungal infection known to cause subcutaneous infection, with rare gastrointestinal manifestations [1,2]
We report a case following the SCARE criteria of 6-year-olds [6], Saudi, male patient who presented to the Emergency department (ED) with abdominal pain, especially in the right lower quadrant, fever, and vomiting

Summary

INTRODUCTION

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 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. Post-operative, the patient was pushed to paediatric intensive care unit (PICU), while still intubated and hemodynamically stable He developed cardiac arrest on the same day and cardiopulmonary resuscitation (CPR) was performed, but he couldn’t be resuscitated. The management was a combination between surgical intervention and medical treatment

Introduction

Case report

Discussion

Conclusion

Ethical approval