Case Report on Gastrointestinal Basidiobolomycosis Mimicking Inflammatory Bowel Disease: Insights and Review of Saudi Literature.

Gastrointestinal basidiobolomycosis (GIB) is a rare invasive fungal infection of immunocompetent hosts that is endemic to Saudi Arabia and the wider Gulf region. Its presentation overlaps with inflammatory bowel disease (IBD), intestinal tuberculosis and malignancy, and many patients reach a definitive diagnosis only after surgery. We report a 39-year-old Saudi woman who presented with a 7-day history of right lower quadrant pain and non-bloody watery diarrhea. Initial bloods showed an elevated C-reactive protein of 21.5 mg/L, an erythrocyte sedimentation rate of 44 mm/hour and an absolute eosinophil count of 0.54 × 103/µL. Contrast-enhanced computed tomography (CT) demonstrated segmental wall thickening of the terminal ileum, cecum and proximal transverse colon, with a 3×5 cm intramural cecal collection. Colonoscopy revealed ulcerated congested mucosa and an ileocecal stricture; targeted biopsies showed an eosinophil-rich granulomatous inflammation with broad, sparsely septate fungal hyphae demonstrating the Splendore-Hoeppli phenomenon, positive on Grocott methenamine silver and periodic acid-Schiff stains; and tissue culture grew Basidiobolus spp. Interventional radiology and surgical drainage were considered but were technically not feasible because of the intramural location, so the patient was managed medically with oral itraconazole at 200 mg every 8 hours for 3 days followed by 200 mg once daily, with monthly liver enzyme monitoring. Surgery was avoided. A repeat CT scan at 2 months showed near complete resolution of wall thickening, and follow-up colonoscopy at 5 months was normal. The patient self-discontinued itraconazole at 9 months because of symptom resolution and remained asymptomatic at follow-up 2 months later. Clinicians working in endemic regions should consider GIB in any patient with an ileocecal mass or abscess, eosinophilia and an IBD-like presentation, because early biopsy with fungal stains and prompt azole therapy can avert surgery.