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Infiltrating, Quasi-Cancerous Rectal Lesions: Unique Manifestation of Visceral Basidiobolus ranarum

  • Abdullah S. Al-Helal
  • Nishith Kumar Jetley
  • Mohammed Ahmed Al Gathradi
  • Adil Al-Shahrani
Original Article
  • 2 Downloads

Abstract

Objective

To report the finding of transmural rectal involvement, in four children with lesions which seemed to be neoplastic in appearance and progression.

Methods

The case records of four children presenting with rectal involvement by the fungus Basidiobolus ranarum, were retrospectively analyzed for clinical presentation, hematological and radiological investigations, the procurement of histopathological material for diagnosis and the findings thereof, the treatment of these patients and the follow-up.

Results

The four children presented with non-specific symptoms of fever, loss of weight and appetite, constipation and bleeding per rectum. One presented with excoriation and ulceration of the perineum and perianal skin. Examination generally unremarkable, however, showed the rectum extensively involved by a lesion which narrowed the lumen. Hematological investigations showed leukocytosis with eosinophilia and raised levels of acute phase reactants like ESR, platelets, and C-reactive proteins. Ultrasonogram (USG) and CT scan confirmed the lesion to be involving all layers of the rectum and compromising the rectal lumen. The right colon was also involved in one patient. One underwent a colonoscopy and biopsy which proved inconclusive. All four underwent a Tru-cut biopsy which was diagnostic. Histopathologically the disease was based in Basidiobolus ranarum, a fungus which is emerging as a cause of visceral abdominal involvement.

Conclusions

Lesions involving the rectum, and appearing to be neoplastic may be caused by the fungus Basidiobolus ranarum. The symptomatology and presentation may be non-specific. High levels of eosinophils in the blood, a raised ESR, and C-reactive protein may be useful pointers to the diagnosis. USG and CT scans localize the lesions and also provide a guide for biopsies. The characteristic histopathological findings are diagnostic and based on these, treatment with Itroconazole / Voriconazole is beneficial.

Keywords

Rectal basidiobolus Quasi-cancerous fungal mass Childhood infiltrating rectal mass 

Notes

Acknowledgments

The authors are grateful to the pathological input provided by Dr. D’Sa, Department of Pathology, Aseer Central Hospital, Abha, Saudi Arabia.

Authors Contributions

ASA-H: Provided the collation of data and reviews concerning the article; NKJ: Contributed to the text and main body of the article; MAA-G: Study and analysis of the radiological material; AA-S: Gastro-enterological inputs and provision of pathological analysis. ASA-H will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

References

  1. 1.
    Al-Jarie A, Al Azraki T, Al Mohsen I, et al. Basidiobolomycosis: case series. J Mycol Med. 2011;21:37–45.CrossRefPubMedGoogle Scholar
  2. 2.
    El-Shabrawi MHF, Kamal NM. Gastrointestinal basidiobolomycosis in children: an overlooked emerging infection. J Med Microbiol. 2011;60:871–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Almoosa Z, Alsuhaibani M, Aldandan S, Alshahrani D. Pediatric gastrointestinal basidiobolomycosis mimicking malignancy. Med Mycol Case Rep. 2017;18:31–3.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lyon GM, Smilack JD, Komatsu KK, et al. Gastrointestinal Basidiobolomycosis in Arizona: clinical and epidemiologic characteristics and review of the literature. Clin Infect Dis. 2001;32:1448–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Geramizadeh B, Foroughi R, Keshtkar-Jahromi M, Malek-Hosseni S, Alborzi A. Gastrointestinal basidiobolomycosis an emerging infection in the immunocompetent host: a report of 14 patients. J Med Microbiol. 2012;61:1770–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Vikram HR, Smilack JD, Leighton JA, Crowell MD, De Petris G. Emergence of gastrointestinal basidiobolomycosis in the United States, with a review of worldwide cases. Clin Infect Dis. 2012;54:1685–91.CrossRefPubMedGoogle Scholar
  7. 7.
    Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13:236–301.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bigliazzi C, Poletti V, Dell’Amore D, Saragoni L, Colby TV. Disseminated basidiobolomycosis in an immunocompetent woman. J Clin Microbiol. 2004;42:1367–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rose SR, Lindsley MD, Hurst SF, Paddock CD, Damodaran T, Bennet J. Gastrointestinal basidiobolomycosis treated with posaconazole. Med Mycol Case Rep. 2013;2:11–4.CrossRefGoogle Scholar
  10. 10.
    Al-Shanafey S, AlRobean F, Bin Hussain I. Surgical management of gastrointestinal basidiobolomycosis in pediatric patients. J Pediatr Surg. 2012;47:949–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Al-Naemi AQ, Khan LA, Al-Naemi I, et al. A case-report of gastrointestinal basidiobolomycosis treated with voriconazole, a rare emerging entity. Medicine (Baltimore). 2015;94:e1430.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Abdullah S. Al-Helal
    • 1
  • Nishith Kumar Jetley
    • 1
  • Mohammed Ahmed Al Gathradi
    • 2
  • Adil Al-Shahrani
    • 3
  1. 1.Department of Pediatric SurgeryAbha Maternity and Children’s HospitalAbhaSaudi Arabia
  2. 2.Department of Radiology, College of MedicineKing Khalid University and Abha Maternity and Children’s HospitalAbhaSaudi Arabia
  3. 3.Department of Pediatric Gastro-enterologyAbha Maternity and Children’s HospitalAbhaSaudi Arabia

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