Letter to the Editor: Ileocecal basidiobolomycosis resembling malignancy - histopathological insights and a justification for nonsurgical therapy

Basidiobolomycosis usually manifests as persistent subcutaneous swelling and hardly infects the gastrointestinal tract. Due to infrequent gastrointestinal involvement along with nonspecific clinical signs, it frequently leads to misdiagnosed cases and treatment delays. Gastrointestinal basidiobolomycosis (GIB) should be recognized as a differential diagnosis in patients with abdominal pain, weight loss, eosinophilia, and an inflammatory mass refractory to non-antifungal therapy, especially if the patient hails from Iran, Saudi Arabia, Kuwait, or desert regions of the United States (primarily Arizona). Histopathological findings, including mixed inflammatory cells, especially eosinophilic infiltration, granulomatous reactions, broad, thin-walled, and aseptate hyphae, and Splendore-Hoeppli phenomenon (radiating intensely eosinophilic material) around fungal hyphae, are highly characteristic of GIB. In this editorial, we comment on the article published by Alsulaimi et al in the World Journal of Clinical Cases, showing a case of 32-year Saudi male with an ileocecal mass. It was confirmed to be GIB on histopathology and was treated by antifungal therapy alone. In this article, we emphasized the importance of histopathology in making the diagnosis of GIB and suggested that more polymerase chain reaction-based methods be used for early identification.