Fungal inflammatory masses masquerading as colorectal cancer: a case report

Abstract

BackgroundNon malignant invasive tumors of the colon and rectum are very rare. Gastrointestinal Basidiobolomycosis can present as a mass lesion mimicking colorectal cancer.Case presentationA 56 year old Caucasian male was evaluated for abdominal and pelvic pain for 4 weeks complicated by acute urinary retention. Radiological evaluation showed him to have recto-sigmoid and cecal mass. Endoscopic examination and biopsies did not reveal a definite diagnosis. Computerized tomography guided biopsy of the mass showed fungal elements consistent with gastrointestinal basidiobolomycosis. He was treated with Itraconazole for 12 months with very good clinical and radiological response.ConclusionBasidiobolomycosis of the gastrointestinal tract should be considered during evaluation of colorectal masses with atypical presentation. It is a rare entity seen more in endemic regions of the world for basidiobolomycosis including southwestern United States.

The Adaptor Protein CARD9 Protects against Colon Cancer by Restricting Mycobiota-Mediated Expansion of Myeloid-Derived Suppressor Cells

“…Recently, the role of commensal microbes in host homeostasis has attracted extensive attention. Gut microbes have been associated with aging (Neyrinck et al, 2017), obesity (Pindjakova et al, 2017), IBD, and colon cancers (Ilyas et al, 2015; Kang and Martin, 2017; Luan et al, 2015; Round and Mazmanian, 2009). As to the regulation of intestinal immunity, commensal Escherichia coli can promote the development of colon tumors in IL10 −/− mice (Arthur et al, 2012).…”

Gastrointestinal basidiobolomycosis: Beware of the great masquerade a case report

“…He was then managed with antifungals without surgical intervention resulting in complete cure. Duration of antifungal therapy in GIB is presently unidentified with most experts recommending a minimum of six months post-surgical resection to minimize risk of relapse [7,10]. This patient received ten months of antifungal therapy (four months of itraconazole followed by six months of voriconazole due to intolerance to itraconazole).…”

“…Gastrointestinal basidiobolomycosis (GIB) is a newly recognized emerging and rare form of the disease with 122 cases reported worldwide as of 2018 [3] of which 46 cases reported in adults [4,5]. GIB is most commonly reported in the tropical and subtropical areas despite the worldwide distribution of Basidiobolus ranarum [6] with most of the reported cases occurring in men [7] from the arid regions of the United States (mainly Arizona) and from Middle East [8]. It is unclear how Basidiobolus ranarum gains access to the host’s gastrointestinal tract.…”

Human Pathogenic Entomophthorales

“…13A to D). 207; soft tissue thickening (126) Frontal hypodensity suggesting intracerebral abscesses, pansinusitis, periorbital edema, orbital inflammation (172) Thickening of the intestines with single or multiple tumor-like masses of the colon or rectum; in cases of disseminated infection, similar masses are found in liver, small bowel, gallbladder, pancreas, kidney, and/or peritoneum (192,203,210) MRI Increase in T2 signals of the nose and soft tissues of the upper lips; involvement of the dorsal cavity and infiltration of maxillary sinuses and nasal concha 167A study of a case of pericarditis caused by C. incongruus found large pericardial effusion, causing pericardial tamponade; irregular echogenic densities were also found near the left ventricle (35) Circumferential thickening of cecum and rectum with significant luminal narrowing; retroperitoneal lymphoadenopathies (211) Traditional X ray Presence of soft tissue and opacities due to nasal and facial swelling, with obstruction of the airway passages of left or right antrum; frontal and maxillary sinusitis; no signs of bone involvement (208) Generalized cardiac enlargement, bilateral pulmonary infiltration, posterior mediastinal tumorlike masses (40); progressive low infiltration of the lungs that soon evolves to adjacent sections of the affected lungs (35,42,50) Abnormal collection of gas in the descending colon region; upper gastrointestinal thickened folds in the fundus and body of the stomach and the proximal duodenum (212) Ultrasound Recorded only for the right foot, attributed to C. incongruus (184) ND Detection of tumor-like masses in abdomen and pelvis and thickening of the colon and rectum (120); heterogeneous mass around the abdominal aorta (203) a Shown are the most common findings with each of the selected procedures. ND, not determined (no reports).…”

“…Likewise, these tools were instrumental in determining the extent of damage in cases of disseminated conidiobolomycosis involving the brain (172) and the lungs (32,35,42,50,209) (Table 4). These methodologies have also been extensively used for cases of intestinal and disseminated basidiobolomycosis (120,140,192,203,(210)(211)(212). Thickening of the intestine and the presence of tumor-like masses in the colon, rectum and, in cases of disseminated infection, liver, gallbladder, pancreas, and kidney were typical findings.…”