Gastrointestinal Basidiobolomycosis in Pediatric Cases With Multiple-Site Involvement: A Case Series

Basidiobolomycosis, a rare fungal infection seen in immunocompetent patients, is a chronic granulomatous infection affecting the skin and subcutaneous tissue. It is caused by the fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis usually has non-specific clinical manifestations, and its diagnosis requires a high index of suspicion. In pediatric patients, any delay or misdiagnosis may lead to morbidity and or mortality. Herein, we report three cases of gastrointestinal basidiobolomycosis from the southern region of Saudi Arabia. The three patients were diagnosed based on histopathology results and computed tomography of the abdomen, with different pathological sites with multiple gastrointestinal tract involvement. Case one was a five-year-old male patient complaining of abdominal pain lasting seven months, weight loss, and fever, with computed tomography (CT) showing involvement of the liver and bowels. Case two was a five-year-old male patient complaining of a fever lasting one month associated with generalized abdominal pain, with CT abdomen showing involvement of the liver, colon, cecum, and mesenteric lymph node. Case three was a seven-year-old female patient complaining of abdominal pain lasting one month, with a CT abdomen showing involvement of the colon and terminal ilium accompanied by mesenteric lymph node involvement. In all three cases, the CT abdomen findings showed involvement of the bowel. All three cases were treated successfully with antifungal monotherapy (itraconazole) without surgical intervention, and all responded well. The aim of this case series was to show the importance of early management for improved outcomes in such cases and to highlight how a diagnosis of gastrointestinal basidiobolomycosis requires a high index of suspicion due to its broad range of clinical presentation. In addition, medical management with itraconazole can be curative without the need for surgical intervention.