Mini-review Diagnosis of gastrointestinal basidiobolomycosis: a mini-review Mortada H. El-Shabrawi, 1 Naglaa Mohamed Kamal, 2 Kerstin Kaerger 3 and Kerstin Voigt 4,5 1 Faculty of Medicine, Cairo University, Cairo, Egypt, 2 Faculty of Medicine, Cairo University, Cairo, Egypt, 3 Faculty of Biology and Pharmacy, Institute of Microbiology, University of Jena, Jena, Germany, 4 Leibniz Institute for Natural Product Research & Infection Biology, Jena, Germany and 5 Faculty of Biology and Pharmacy, Institute of Microbiology, University of Jena, Jena, Germany Summary Basidiobolus ranarum (Entomophthoromycotina) very rarely affects the gastrointesti- nal (GI) tract. To date, reported paediatric GI basidiobolomycosis cases are 27 world- wide; 19 from Saudi Arabia and 8 from other parts of the world. Often these cases present a diagnostic dilemma, are prone to misdiagnosis and lack of disease confir- mation by proper molecular methodologies. The fungal mass removed by surgery is usually sent for conciliar histopathology, isolation by fungal cultures and final molecular testing for basidiobolomycosis. The incidence of basidiobolomycoses, their predisposing factors and the molecular diagnosis of the fungus causing the disease in combination with a phylogenetic framework are reviewed. Key words: 18S rRNA, gastrointestinal basidiobolomycosis, identification, molecular typing, Splendore–Hoeppli phenomenon. Basidiobolomycosis: main characteristics of a rare chronic subcutaneous disease Basidiobolomycosis is an unusual, rare fungal skin infection causing chronic subcutaneous zygomyco- sis. 1,2 It is caused by Basidiobolus ranarum (Entomopht- horomycotina) 3,4 with human disease concentrated in tropical and subtropical regions. Extracutaneous involvement is extremely rare 5 with gastrointestinal (GI) involvement being exceedingly rare 6–10 ; with only 66 adult and 27 paediatric cases reported worldwide. Most adult cases, 19 patients, were from the United States of whom 17 [89%] were from Arizona 11 ; whereas 14 patients were from Iran, 11 12 patients from Iraq, 12 11 from the Kingdom of Saudi Arabia (KSA) 11 and 4 from Brazil. 11 The remaining six patients were one from each of Nigeria, India, Bangladesh, Italy, Netherlands and one with unreported country of origin. 11 The 27 reported paediatric patients are summarised in Table 1, 12–24 where 19 patients are from KSA, 3 from Iran, 2 from Iraq, 2 from Brazil and 1 from Nigeria. All reported paediatric gastrointestinal basidiobol- omycosis (GIB) cases were males with no significant medical history or apparent predisposing factor(s), age ranged between 1.5–13 years, and presented with fever and abdominal pain as their main symptoms. Leucocytosis with marked eosinophilia, high erythro- cyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in all cases. 10,25 Abdominal exami- nation revealed intra-abdominal masses in all cases and were confirmed by abdominal ultrasonography and computed tomography. Almost all cases were misdiagnosed as other chronic granulomatous diseases or malignancies. 25 Some examples are: (i) AlJarie series, 16 where two patients were misdiagnosed as appendicitis with appendicular mass, two as abdominal tuberculosis and two as lym- phomas, (ii) Khan and his colleagues’ patient was also misdiagnosed as intestinal tuberculosis, 9 (iii) Fahimzad and his colleagues, 17 initially didn’t achieve diagnosis and titled their patient as inflammatory granuloma with undetermined aetiology, (iv) Nguyen’s patient was misdiagnosed as Crohn’s disease, 2 etc. Correspondence: Naglaa Mohamed Kamal, MD, Associate Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt. Tel.: +00201141991114. Fax: +20237619012. E-mail: nagla.kamal@kasralainy.edu.eg or nagla.kamal@medicine.cu.edu.eg Submitted for publication 21 December 2013 Revised 18 June 2014 Accepted for publication 18 June 2014 © 2014 Blackwell Verlag GmbH Mycoses, 2014, 57 (Suppl. 3), 138–143 doi:10.1111/myc.12231 mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases