Gastrointestinal basidiobolomycosis presenting as an inflammatory colonic pathology: management challenges

Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by Basidiobolus ranarum that predominantly affects immunocompetent individuals in tropical and subtropical regions and often mimics appendicitis, inflammatory bowel disease, or malignancy, resulting in delayed diagnosis and inappropriate management. A 38-year-old woman was previously treated for presumed Crohn's disease or appendicular abscess without improvement and presented with persistent right-iliac-fossa pain, fever, palpable mass, and markedly elevated inflammatory markers. Computed tomography demonstrated a retrocecal inflamed appendix with peri-appendiceal collection, and clinical deterioration despite antibiotics and unsuccessful drainage necessitated laparoscopic appendectomy, followed by exploratory laparotomy and right hemicolectomy. Histopathology with special stains confirmed GIB, and itraconazole therapy resulted in progressive clinical recovery. GIB can closely mimic common inflammatory or malignant abdominal conditions, leading to diagnostic delay and repeated interventions; early clinical suspicion in endemic regions and prompt histopathological confirmation are essential to guide definitive surgical and antifungal management.