A Case Series of Adult and Pediatric Basidiobolomycosis in Saudi Arabia: An Emerging Rare Disease

Abstract

Background: Basidiobolomycosis is a fungal infection caused by Basidiobolus ranarum. It is primarily located in the tropical areas. It is commonly affecting the gastrointestinal tract and rarely presents with systemic affection.

Patients and Methods: The records of fifteen patients, including pediatrics, from various geographic regions (western and southern regions of the Kingdom of Saudi Arabia) who were diagnosed with basidiobolomycosis in two tertiary hospitals over the last fourteen consecutive years from January 2010 to February 2023 were included. A detailed history and data for each patient were reviewed and evaluated.

Results: A total of fifteen patients were found to have basidiobolomycosis, of which fourteen were found to have gastrointestinal basidiobolomycosis (GIB). They presented with abdominal pain, fever, nausea, vomiting, diarrhea, and loss of weight. One of them with an orbital infection presented with periorbital swelling, hotness, and redness. The diagnosis was confirmed after histopathological examination with typical features of granulomatous reaction, dense infiltrate of eosinophils, and fungal structures. Seven patients were treated with antifungals alone, such as voriconazole or itraconazole. Eight patients were treated by surgical resection followed by antifungal medication. Ten patients demonstrated good clinical response and completed their treatment course, while one patient showed a slight improvement and is still receiving treatment and follow-up. There have been four reported cases of death. The length of the therapy was scheduled based on how the patients responded clinically to the intervention.

Conclusions: We present the series with the most patients collected to date, and it is shown that GIB is often misdiagnosed as cancer or inflammatory bowel disease. Histological analysis confirms the diagnosis of basidiobolomycosis. The choice of therapy is still up for debate: medical intervention alone or surgical resection followed by antifungal medication.