Fungal Infections Masquerading as Gastrointestinal Tract Malignancies – A Series of Three Cases
AbstractFungal infections of the gastrointestinal tract (GIT) are not rare, but get missed due to their misleading clinical features. Here we report three GIT fungal infections at different locations with varied symptoms. We received surgical resection specimens with the clinical suspicion of malignancy for all. The first was a case of Aspergillosis, at an uncommon site, esophageal, in a 60year diabetic male with a suspicion of carcinoma in view of presence of dysphagia and a stricture on CT. The second was a 60-year male, a case of stomach Zygomycosis with no definite immunosuppression, who presented with an intra-operative suspicion of malignancy, and showed fungal angio-invasion and ischemic perforation. Third was a 32year immunocompetent male, a case of GI histoplasmosis with an uncommon presentation, showing obstructive symptoms due to an ileocaecal mass with a clinical suspicion of TB/malignancy. Thus, a high index of suspicion for fungal a etiology in GIT is essential, because misdiagnosis can lead to a radical surgery. Timely treatment with appropriate antifungal therapy is crucial as high mortality is associated with certain fungi.
Lamps LW, Lai KKT, Milner DA. Fungal Infections of the Gastrointestinal Tract in the Immuno-compromised Host-An Update. Adv Anat Pathol 2014; 21: 217–227
Mishra P, Gupta D, Mishra S, Srinivas V. Aspergillosis of Gastrointestinal Tract Mimicking Malignancy: A Case Report. J Clin Exp Pathol 2017;7:1-3
Odze RD, Goldblum JR. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Infect Dis GI Tract 2009; 51-79
Shankaralingappa S. Unsuspected invasive gastrointestinal mucormycosis masquerading as inflammatory bowel disease: A pathologist's perspective. Indian J Pathol Microbiol 2019; 62:332-4
Nakshabendi R, Berry AC, Miranda D, LaBarbera FD, Kanar O, Nakshabandi A, Nakshabendi I. Primary Histoplasma capsulatum Enterocolitis Mimicking Peptic and Inflammatory Bowel Disease. Case Reports in Gastrointestinal Medicine 2016; 1-3
Praneenararat S. Fungal infection of the colon. Clinical and Experimental Gastroenterology 2014:7 415–426
Lamps LW. Infectious Disorders of the GI Tract. In: Surgical Pathology of the Gastrointestinal Tract, Liver, Biliary Tract and Pancreas 2009; p.51-79
Cha SA, Kim MH, Lim TS, Kim HH, Chang KY, Park HS et al. Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors. Yonsei Med J 2015;56:1453-56
Eggimann P, Chevrolet JC, Starobinski M, Majno P, Totsch M, B. Chapuis B. et al. Primary invasive aspergillosis of the digestive tract: report of two cases and review of the literature. Infection 2006; 34: 333–38
Kazan E, Maertens J, Herbrecht R, Weisser M, Gachot B, Vekhoff A et al. A retrospective series of gut aspergillosis in haematology pa¬tients. Clin Microbiol Infect 2011; 17: 588-94
Patra S, Vij M, Chirla DK, Kumar N, Samal SC. Unsuspected invasive neonatal gastrointestinal mucormycosis: A clinico-pathological study of six cases from a tertiary care hospital. J Indian Assoc Pediatr Surg 2012; 17:153-6
Sruthi J, Shrivalli N, Aruna Raman P and Ashitha S. Colonic Angioinvasive Mucormycosis - Case Report. Austin J Radiol 2019; 6: 1094
Debata et al. An unusual presentation of colonic mucormycosis mimicking carcinoma colon- a surgeon’s perspective International Journal of Surgery Case Reports 2015; 10: 248–51
Lee ZJ, Chia C, Busmani I, Wong WK. A rare cause of ischemic gut: A case report. International Journal of Surgery Case reports 2016; 20:114-17
Choi WT, Chang TT, Gill RM. Gastrointestinal Zygomycosis Masquerading as Acute Appendicitis. Case Rep Gastroenterol 2016;10:81–87
Sehgal S, Chawla R, Loomba PS, Mishra B. Gastrointestinal Histoplasmosis presenting as colonic pseudotumour. Indian journal of Medical Microbiology 2007; 26: 187-189
Romano RC, Soape MM, Thirumala S, Ghandour E. Disseminated histoplasmosis mimicking metastatic disease of the colon and omentum: Report of a case and literature review. Arab Journal of Gastroenterology 2015; 16 : 66–68
Doleschal B, Rodhammer T, Tsybrovskyy O, Achberger KJ, Lang F. Disseminated Histoplasmosis: A Challenging Differential Diagnostic Consideration for Suspected Malignant Lesions in the Digestive Tract. Case Rep Gastroenterol 2016;10:653–60
Bauddha NK, Jadon RS, Mondal S, Vikram NK, Sood R. Progressive disseminated histoplasmosis in an immunocompetent adult: A case report Intractable & Rare Diseases Research 2018; 7:126-129
Subramanian S, Abraham OC, Rupali P, Zachariah A, Mathews MS, Mathai D. Disseminated histoplasmosis. J Assoc Physicians India. 2005;53:185-9
Randhawa HS, Gugnani HC. Occurence of Histoplasmosis in the Indian Sub-Continent: An Overview and Update. J Med Res Prac 2018; 7: 71–83
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).