Gastrointestinal Basidiobolomycosis Mimicking Adhesive Bowel Disease and Ileocaecal Malignancy in an Adult HIV Patient: A Case Report Highlighting a Diagnostic Pitfall.

INTRODUCTION: Fungi cause gastrointestinal basidiobolomycosis (GIB). It often presents with features that are difficult to differentiate from other gastrointestinal disorders such as malignancy and inflammatory bowel disease. This results in a misdiagnosis and delayed initiation of appropriate treatment.

CASE PRESENTATION: We present a case of a 41-year-old female, who had been HIV positive for over 20 years on antiretroviral therapy. The patient presented with intestinal obstruction. She had experienced similar episodes over the preceding month and was managed conservatively but without complete resolution. The patient also had a history of abdominal surgery; however, the indications were unclear. Emergency laparotomy revealed a tumor-like mass at the ileocecal junction, suggestive of malignancy. Tumor resection with ileotransverse anastomosis plus adhesiolysis were performed. Histopathological examination revealed chronic granulomatous inflammation with eosinophilic infiltrates in addition to fungal spores, consistent with a gastrointestinal fungal infection. The postoperative course was complicated by surgical site infection and anemia. Following the histological diagnosis, itraconazole therapy was initiated, after which the surgical site infection rapidly improved.

CONCLUSION: Gastrointestinal basidiobolomycosis should be considered in patients presenting with recurrent intestinal obstruction and ileocecal masses, particularly when intraoperative findings mimic malignancy. In particular, among patients with previous surgery, gastrointestinal basidiobolomycosis should be considered among the differential diagnoses when patients present with features of intestinal obstruction, to avoid delayed intervention.