The Splendore-Hoeppli phenomenon in hepatic botryomycosis

Primary orbital chronic granulomatous reaction to deep staphylococcal infection due to trauma in immunocompetent

A 53-year-old man presented with a slow-growing mass in the right orbit and temporal area of 1 year duration following a road traffic accident. Examination revealed a nodular fungating mass involving the orbit, right temporal area with multiple discharging sinuses causing proptosis and restricted ocular motility. The patient denied light perception in the right eye. There was exposure keratopathy and optic atrophy. Imaging showed mass lesion of the orbit extending intracranially. Tissue biopsy and culture revealed a chronic granulomatous reaction due to deep infection with coagulase-positive staphylococci. The patient showed remarkable improvement to systemic antibiotics and anticonvulsants. Mortality is high in such cases due to intracranial extension if there is a delay in treatment. This case report summarises a rare aetiology and successful treatment of a case of chronic granulomatous reaction due to deep bacterial infection following trauma and is deemed rare as cases of primary orbital infection in immunocompetent have not been reported so far.

Botryomycosis — a series of six integumentary or visceral cases from India

Botryomycosis is characterized by a chronic suppurative lesion with distinctive fungus-like grains that resemble the sulphur granules of actinomycosis. Both integumentary and visceral forms of the disease are recognized. The visceral involvement occurs predominantly in the lungs. Botryomycosis may develop in apparently healthy individuals as well as the immunologically compromised. Six cases of botryomycosis, affecting various sites in the bodies of immunocompetent individuals, are described. In each of the six cases, the initial clinical diagnosis was of an abscess or malignancy.

Gastrointestinal basidiobolomycosis: an unusual fungal infection mimicking colon cancer

CONTEXT

-Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum, an environmental saprophyte found worldwide. Patients with B ranarum infection may present with subcutaneous, gastrointestinal, or systemic lesions. Gastrointestinal basidiobolomycosis poses diagnostic difficulties, as its clinical presentation is nonspecific, with no identifiable risk factors.

OBJECTIVE

-To discuss and compare the clinical features and histopathologic findings and other ancillary techniques that could be helpful in identifying gastrointestinal basidiobolomycosis.

DESIGN

-We report 3 cases of gastrointestinal basidiobolomycosis and describe the clinical and morphologic findings while emphasizing the importance of identifying this unusual entity on endoscopic biopsies, thus avoiding unnecessary major surgeries. Fungal cultures were also performed, which are of diagnostic significance. Our first patient was lost to follow-up; however, patients 2 and 3 were followed up for 4 and 2 years, respectively.

RESULTS

-In all 3 cases, patients presented with a clinical profile suggestive of malignancy. None of the patients gave any specific history. There was widespread abdominal disease with peritoneal involvement and colonic masses. Colonoscopic biopsy specimens showed nonspecific inflammation in 1 case; however, they showed only granulomatous inflammation in a second case and granulomas associated with fungal hyphae in a third. Typical morphology included hyphae, irregularly branched, thin-walled, occasionally septated and surrounded by a thick eosinophilic cuff (Splendore-Hoeppli phenomenon).

CONCLUSION

-Gastrointestinal basidiobolomycosis can be detected on small endoscopic biopsy. The unequivocal diagnosis requires microbiologic cultivation of the fungus obtained from tissues. The prognosis for this disease is usually favorable as seen in 3 of our cases; however, cases with fatal outcome are on record.

Histological and ultrastructural features of gastrointestinal basidiobolomycosis

Basidiobolus ranarum is a fungus found in the dung of amphibians, reptiles, and insectivorous bats. Its structural elements include both hyphae and zygospores. Patients with B. ranarum infection may present with subcutaneous, gastrointestinal, or systemic lesions. Here we report a case of gastrointesinal badidiomycosis in a 13-year-old male child who presented with acute abdomen. Exploration revealed a mass in the ascending colon. On histology, transmural granulomatous inflammation composed of abundant eosinophils, lymphocytes, histiocytes and giant cells was seen. Histochemical stains revealed broad, non-septate, hyphae-like structures surrounded by an eosinophilic sheath. On an ultrastructural level, fungal hyphae, spores, and macrophage-laden crystalloids were observed. The diagnosis of gastrointestinal basidiobolomycosis was established and the patient received antifungal treatment. This paper reviews the relevant literature regarding basidiomycosis, and discusses its diverse clinicopathological features, as well as distinguishing it from other diseases.