Basidiobolus ranarum is a known cause of subcutaneous zygomycosis, Recently
, its etiologic role in gastrointestinal infections has been increasingly r
ecognized. While the clinical presentation of the subcutaneous disease is q
uite characteristic and the disease is easy to diagnose, gastrointestinal b
asidiobolomycosis poses diagnostic difficulties; its clinical presentation
is nonspecific, there are no identifiable risk factors, and all age groups
are susceptible. The case of gastrointestinal basidiobolomycosis described
in the present report occurred in a 41-year-old Indian male who had a histo
ry of repair of a left inguinal hernia 2 years earlier and who is native to
the southern part of India, where the subcutaneous form of the disease is
indigenous. Diagnosis is based on the isolation of B. ranarum from cultures
of urine and demonstration of broad, sparsely septate hyphal elements in h
istopathologic sections of the colon, with characteristic eosinophilic infi
ltration and the Splendore-Hoeppli phenomenon. The titers of both immunoglo
bulin G (IgG) and IgM antibodies to locally produced antigen of the fungus
were elevated. The patient failed to respond to 8 weeks of amphotericin B t
herapy, and the isolate was later found to be resistant to amphotericin B,
itraconazole, fluconazole, and flucytosine but susceptible to ketoconazole
and miconazole. One other noteworthy feature of the fungus was that the pat
ients serum showed raised levels of Th2-type cytokines (interleukins 4 and
10) and tumor necrosis factor alpha. The present report underscores the nee
d to consider gastrointestinal basidiobolomycosis in the differential diagn
osis of inflammatory bowel diseases and suggests that, perhaps, more time s
hould be invested in developing standardized serologic reagents that can be
used as part of a less invasive means of diagnosis of the disease.