Colonic Basidiobolomycosis Unusual Lethal Fungal Infection: A Case Series

Background: Basidiobolomycosis is a rare manifestation of Basidiobolus ranarum infection. It is a saprophyte fungus that inhibits soil and moldy vegetables. It mainly infects immunocompetent patients. Tropical and subtropical regions are the preferred habitat. It occasionally causes granuloma of the infected organs.Objective: In this report, we present five cases of colonic Basidiobolomycosis and discuss their presentation, diagnostic procedures, treatment, and prognosis.Patients and Methods: We recorded five patients who presented with acute abdomen and palpable abdominal masses in the general surgery department of Muhayil General Hospital (tertiary care hospital, Saudi Arabia) from January 2019 to December 2020. CBC revealed leukocytosis with relative eosinophilia. All patients underwent pelviabdominal CT with intravenous contrast and fiberoptic colonoscopy. The first, second, and fifth patients underwent limited colonic resection. The third and fourth patients received itraconazole.Results: Biopsies revealed the Splendore-Hoeppli phenomenon and fungal elements, leading to the diagnosis of colonic Basidiobolomycosis. Treatment started with antifungal itraconazole 200 mg iv/12 h followed by oral itraconazole tab 100 mg. Itraconazole led to significant improvement in symptoms and laboratory indices after one week. Of the three patients who underwent extensive colonic surgery, two died, and one recovered.Conclusion: Rare fungal infections should be considered in the differential diagnoses of patients presented with abdominal pain, obstruction, or masses, especially in endemic areas.