The Royal hospital experience Gastrointestinal Basidiobolomycosis, an emerging fungal infection of the gastrointestinal tract,   The Royal hospital experience Mohammed al-Masqari, Fatma Al-Lawti , Amal Al-Maani Introduction Materials and Methods Results Conclusion Basidiobolomycosis is a rare disease caused by the fungus Basidobolus ranarum, an environmental saprophyte found world wide .It is well known that this infection is manifested with skin disease and rarely involve the gastrointestinal tract. Gastrointestinal Basidobolus mycosis poses diagnostic difficulties, as it is clinical presentation is not specific and can mimic other serious diseases like malignancy. Lack of awareness of GIB has resulted in its delayed diagnosis and in extensive morbidity and mortality in patients with GIB. In this case series we are retrospectively reviewed 5 cases diagnosed in the Royal hospital 2008 to 2014. It will be the largest reported series in patient with GIB in Oman. The cases are identified by reviewing medical records through Al-Shifa system. In order to ensure that all cases are included, patients diagnosed with any GI fungal infection for the past 8 years are reviewed again by a resident and a consultant pathologist. The defined cases are confirmed on the bases of the characteristic histolopathologic appearance of broad, thin-walled, pleomorphic hyphae surrounded by a collar of eosinophilic material (known as the Splendore-Hoeppli phenomenon). Diagnosis of GIB requires high index of suspicion, Increased awareness of this rare disease help reach an early diagnosis and prompt starting treatment. The clinical features of which resemble those of Inflammatory or neoplastic bowel disease. Whenever these diagnoses are entertained, basidiobolomycosis might be considered in the differential diagnosis. Acknowledgments The researchers would like to thank the research department at Oman medical specialty board for supervising this research. Objectives To examine epidemiology, clinical characteristics, histopathology findings, ancillary techniques which are important for diagnosis, management and outcome of an uncommon manifestation caused by the Basidobolus ranarum.

Radiological findings Demographic data Clinical presentation Laboratory findings Radiological findings Histopathology Initial Impression Management outcome 1 9 year, male Ad Dakhiliyah Abdominal pain mass vomiting diarrhea Hypochromic microcystic anemia , leukocytosis, thrombocytosis, eosinophelia , CRP:205 HIV,neg Large locualted abscess in the right side of abdomen. Marked inflammation Eosinophilic infiltrate branching Fungal hyphae within pink eosinophilic materials appendicitis Mucormycosis Appendectomy Labrotomy Antibiotics Itraconazole, parentral was not available Died from : DIC, Fungal sepsis 2 19 year Female fever vomiting Cough Hypochromic microcystic anemia, leukocytosis thrombocytosis Eosinophelia ,CRP:196.5 HIV negative Diffuse gastric, small intestine , large intestine wall thickening Pneumonia Caspofungin Ambisome acyclovir Died from: Severe fungal sepsis 3 45 year Male Al Dhahirah abdominal pain diarrhea weight loss Hypochromic microcystic anemia , leukocytosis, thrombocytosis eosinophelia CRP:152.6 Diffuse irregular thickening of cecum, ascending colon and transverse colon. lymphoma schiostomiasis fungoma mucormycosis Ambisome Rt hemecolectomy Severe fungal sepsis 4 5 year Hypochromic microcystic anemia ,leukocytosis CRP:199.0 Diffuse irregular thickening of the right side of the colon GIB (KSA) Rt hemecolectomy Voriconazole Pt clinically improved and discharged home with oral voriconazole Doing well 5 10 year Muscat poor appetite Hypochromic microcystic anemia CRP:0.2 Right subhepatic ileocecal mass obstruction Basidobolus mycosis Discharged on voriconazole