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Trucut needle biopsy used to diagnose rectal Basidiobolus infection mimicking neoplasm in children

September 06 2018

Fungal infections can be difficult to diagnose because they can mimic other conditions. Al-Helal and colleagues at Abha Maternity and Children’s Hospital (Saudi Arabia) recently described four cases of suspected rectal neoplasm that were in fact fungal lesions.

The children presented with non-specific symptoms including fever, weight loss, constipation and bleeding from the rectum. Blood tests showed leucocytosis with raised acute phase reactants (ESR, platelets, CRP). Radiological examination showed a lesion involving all four layers of the rectum that narrowed the lumen, but colonoscopy was inconclusive.

In each case a Trucut needle biopsy was diagnostic, with histopathology revealing broad septate hyphae surrounded by eosinophilic material (Splendore-Hoeppli phenomenon), indicating Basidiobolus ranarum. Treatment with itraconazole/voriconazole was successful.

 

Figure from Ageel et al (2017) showing Splendore-Hoeppli phenomenon of GI basidiobolomycosis biopsy stained with PAS.