A rare case of colon obstruction due to gastrointestinal basidiobolomycosis in a 36-year-old woman

INTRODUCTION: Gastrointestinal basidiobolomycosis (GIB) is an uncommon fungal infection caused byBasidiobolus ranarum, with less than 80 cases reported in the literature. PRESENTATION OF CASE: A 36-year-old woman presented with colicky upper abdominal pain for 2 months and inability to pass stool for 2 days. Computed tomography of the abdomen and colonoscopy both showed a mass in the transverse colon. Colonoscopic biopsy suggested a zygomycosis. Laparotomy revealed a perforated mass in the transverse colon; the mass also involved the small bowel and stomach. En bloc resection was performed, and the incision was closed for a second-look procedure. The patient was admitted to the intensive care unit and placed on a ventilator and inotropes; however, her condition deteriorated, and she died on day 24 post admission. The histopathology report (obtained after the patient’s death) was consistent with GIB. DISCUSSION: Gastrointestinal basidiobolomycosis presents with nonspecific signs and symptoms and so the diagnosis is easily missed or delayed. Timely, accurate diagnosis is crucially important, especially when there is intestinal obstruction and sepsis. Persistent severe abdominal pain in a patient with neutropenia should alert the physician to the possibility of a fungal infection. There are reports from several countries of basidiobolomycosis in immunocompetent hosts. The disease shows no age predilection, but males may be more susceptible. Treatment is with surgical debridement and antifungal drugs—ideally the lipid formulation of amphotericin B. CONCLUSION: Gastrointestinal basidiobolomycosis is a rare infection that can be fatal if not diagnosed and treated early.