Entomoftoromicose intestinal: relato de caso

Abstract

RELATO DE CASOPaciente de 19 anos, agricultor, natural e procedente de Araguaiana (Mato Grosso, Brasil), admitido no hospital com história de massa abdominal, evoluindo há 3 meses, associada à febre, sudorese, diarréia e perda de 9kg no período. O paciente tinha antecedentes alimentares de ingestão de pães mofados.Ao exame físico, estava em regular estado geral e à palpação do abdome havia uma tumoração na fossa ilíaca direita, de 4 por 6cm, endurecida, dolorosa e pouco móvel. Os achados laboratoriais revelaram leucocitose de 12.600/mm 3 , com 11% de eosinófilos, velocidade de hemossedimentação de 49mm/h e função hepática normal. O raio X do tórax era normal e no exame radiológico do trânsito intestinal observou-se grande lesão infiltrativa envolvendo válvula íleo-cecal, ceco e cólon ascendente com grande aumento das partes moles. À colonoscopia, visualizou-se, no cólon ascendente, mucosa edemaciada, hiperemiada, com segmentos ulcerados e pólipos de tamanho v a r i a d o s , s e n d o q u e e s s a s a l t e r a ç õ e s estendiam-se até o ceco. As biópsias realizadas tiveram laudo histopatológico sugestivo de doença de Crohn. Foi então instituído tratamento clínico com sulfasalazina (2g/dia) e ácido fólico, durante 2 meses, sem melhora satisfatória.Devido o paciente não apresentar melhora clínica e à possibilidade deste processo tumoral ter áreas de malignização, optou-se pelo tratamento cirúrgico. O paciente foi submetido à intervenção cirúrgica em 19/04/89, sendo encontrado tumor que iniciava no íleo terminal (5cm distais) avançando pelo cólon ascendente até o ângulo hepático englobando válvula íleo-cecal, apêndice e ceco. O mesentério da região próxima ao tumor apresentava grandes linfonodos. Foi realizada hemicolectomia direita com ileocoloanastomose. O paciente evolui bem, recebeu alta no nono dia pós-operatório, sendo acompanhado ambulatorialmente.No exame anatomopatológico, observou-se uma peça cirúrgica compreendendo íleo (15cm), ceco, cólon ascendente e cólon transverso (10cm). A serosa apresentava-se brilhante com múltiplas nodulações superficiais,

Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature

“…Eight of these 19 patients had been described separately before being finally reviewed by Vikram et al, in 2012 together with other 25 cases observed outside the United States [21]. All the detailed published cases (with the exception of 12 cases reported in the review by Vikram and not singularly described) plus the one observed by us are summarised in Table 2 [4,12,[14][15][16][17][18][19][20]. We noted that a further 18 pediatric cases of basidiobolomycosis were reported in 2017 but they are not included in the present review because of the lack of any detailed information regarding single cases [63].…”

“…Although a definite diagnosis can be obtained with culture [14,15,18,19,[22][23][24]30,33,35,41,45,47,[49][50][51]54,59,62], it was frequently missed in previous reports because of the lack of suspicion that made tissue specimens unavailable for culture purpose. Therefore, the diagnosis of gastrointestinal infection by B. ranarum was mainly obtained on histologic examination, which typical morphologic features include granulomatous inflammation and a diffuse eosinophilic infiltrate with thin walled branched hyphae surrounded by eosinophilic material (Splendore-Höeppli phenomenon) and sometimes zygospores (spherical bodies with foamy cytoplasm) [4,6,12,16,17,20,24,[26][27][28][29][31][32][33][35][36][37][38][39][42][43][44]46,49,52,53,…”

“…Gastrointestinal basidiobolomycosis (GIB) has been considered an extremely rare disease with only six cases reported in the literature up to 1994 [4,12,[14][15][16]. However, starting from 1995 a cluster of cases of GIB was described from Arizona with 19 patients (89% resident in Arizona) identified between 1995 and 2009 at Mayo Clinic, Scottsdale (Arizona) [17][18][19][20].…”

“…decades a 15-fold increase in cases of gastrointestinal infection by B. ranarum has been reported worldwide. Although most of the cases have been described in the Middle East (Saudi Arabia, Iran, Iraq, Kuwait, Oman, Qatar) [23-26,29,31-39,41-46,48-50,52-55,57,60,62] and the southwestern of United States (Arizona and Utah)[15,[17][18][19][20]40,47,56], sporadic reports came from South America, Africa, Europe and the Indian Subcontinent[4,12,14,16,27,28,30,51,59,PR] and no clear environmental risk factors have been identified. In the case-control study performed by Lyon et al in Arizona, ranitidine use (OR 6.0) and a longer period of smoking (OR 2.1/additional 20 years of smoking) were both associated with the development of the disease…”

Entomophthoromycosis: a challenging emerging disease

“…Currently, most cases of conidiobolomycosis are reported from the African continent, mainly Nigeria. 36 There is a 10 : 1 male/female ratio, and the disease occurs predominantly in young adults. 1,2 Conidiobolus is transmitted by inhalation of fungal spores, which then invade the nasal tissue, the paranasal sinuses and facial soft tissues.…”