Hepatic basidiobolomycosis in a 2-year-old child: A case report

Abstract

Introduction

Isolated hepatic basidiobolomycosis is infrequently reported in the literature. Hepatic involvement is typically associated with disseminated disease. Hepatic basidiobolomycosis can mimic hepatic malignancies, posing a diagnostic and therapeutic challenge.

Case presentation

A 2-year-old male was referred to us with a two-month history of abdominal pain and a right upper quadrant abdominal mass. He had no history of vomiting, jaundice, decreased appetite, or diarrhea. Laboratory tests showed leukocytosis (white blood cell count of 15.5 × 10⁹/L) with normal eosinophil count, elevated C-reactive protein (CRP; 30 mg/L; normal: <3 mg/L) and elevated erythrocyte sedimentation rate (ESR; 83 mm/h; normal: <10 mm/h). Liver function tests were within normal limits. Abdominal ultrasonography (USG) showed a well-defined isoechoic homogenous 7 × 7 × 6 cm mass-like lesion in the right hepatic lobe. An abdominal computed tomography (CT) scan confirmed a localized irregular hypodense area in the right hepatic lobe, raising concerns for a hepatic abscess or malignancy. However, tumor markers were not able to be measured. A true-cut needle biopsy showed primarily normal liver tissue with eosinophilic infiltration, proving inconclusive. Fungal cultures were unavailable. The patient was taken to the operating room for an exploration. We find a non-encapsulated mass in the right hepatic lobe, without any other gastrointestinal involvement. Intraoperative biopsies were not available, so we decided to proceed with a complete resection of the mass. The histopathological analysis showed Splendore-Hoeppli bodies and eosinophils around thin-walled hyphae, strongly supporting the diagnosis of basidiobolomycosis. The patient recovered well from the operation and received voriconazole (6 mg/kg every 12 hours) for six months. At two years of follow-up, he has no signs of recurrence.

Conclusion

Hepatic basidiobolomycosis should be included in the differential diagnosis of children with a painful hepatic mass. The lack of proper diagnosis can lead to unnecessary liver resections.