背景:担子菌病是一种罕见的由罗氏担子菌引起的真菌感染。
方法:一名来自沙特阿拉伯的53岁男子,已知有憩室病病史,表现为严重的腹痛和腹泻。CT扫描显示降结肠和乙状结肠周围壁增厚,周围脂肪绞合,提示诊断为复杂憩室炎。在受影响区域周围观察到额外的浓稠流体。进行了手术切除。对两个接受的大肠段进行粗略检查,发现明显的溃疡粘膜和壁增厚,渗出液覆盖的浆膜表面和粘连。显微镜检查揭示了嗜酸性粒细胞的明显浸润,多形核白细胞,和肉芽肿性炎症.薄壁,广泛的真菌菌丝,被嗜酸性物质包围,已确定。肉芽肿在中央坏死或脓肿形成周围显示出丰富的多核巨细胞和栅栏组织细胞。薄壁,广泛的真菌菌丝,稀疏的败血症,被辐射包围,强烈嗜酸性粒细胞袖带(Splendore-Hoeppli现象)。这些菌丝,苏木精和曙红染色可见,用高碘酸-希夫和高森甲胺银染进一步突出显示。
结论:担子菌病可以模拟肿瘤性病变。组织学上,特征包括广泛,由嗜酸性物质包围的薄壁隔膜菌丝,Splendore-Hoeppli现象加剧了这一发现。显微镜检查,以及特殊的污渍,如高碘酸希夫(PAS)和Gomori次甲基胺银,对准确诊断至关重要。
结论:迅速识别和适当的抗真菌治疗对于患者的良好预后至关重要。本报告强调了Basidiobolomycosis的显着特征,以提高对这种罕见但临床上重要的真菌感染的认识和理解。
BACKGROUND: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum.
METHODS: A 53-year-old man from Saudi Arabia with a known history of diverticulosis presented with severe abdominal pain and diarrhea. A CT scan revealed circumferential wall thickening of the descending and sigmoid colon with surrounding fat stranding, suggesting a diagnosis of complicated diverticulitis. Additional thick fluid was observed around the affected area. Surgical excision was pursued. A gross examination of two received large bowel segments disclosed marked ulcerated mucosa and wall thickening with exudate-covered serosal surfaces and adhesions. Microscopic examination unveiled significant infiltration by eosinophils, polymorphonuclear leukocytes, and granulomatous inflammation. Thin-walled, broad fungal hyphae of Basidiobolus, surrounded by eosinophilic material, were identified. Granulomas displayed abundant multinucleated giant cells and palisading histiocytes around central necrosis or abscess formation. Thin-walled, broad fungal hyphae of Basidiobolus, with sparse septations, are surrounded by a radiating, intensely eosinophilic cuff (Splendore-Hoeppli phenomenon). These hyphae, visible with hematoxylin and eosin staining, were further highlighted with periodic acid-Schiff and Gomori methenamine silver staining.
CONCLUSIONS: Basidiobolomycosis may mimic neoplastic lesions. Histologically, the characteristic features include broad, thin-walled septate hyphae surrounded by eosinophilic material, a finding that is accentuated by the Splendore-Hoeppli phenomenon. Microscopic examination, along with special stains such as periodic acid-Schiff (PAS) and Gomori methenamine silver, is essential for accurate diagnosis.
CONCLUSIONS: Prompt recognition and appropriate antifungal therapy are vital for favorable patient outcomes. This report highlights the distinctive features of Basidiobolomycosis to raise awareness and understanding of this infrequent yet clinically significant fungal infection.