RESUMO
Basidiobolomycosis is a rare curable fungal infection caused by the saprophytic fungus Basidiobolus ranarum. It often causes skin infections but rarely infects visceral tissues in humans. Gastrointestinal basidiobolomycosis is an emerging form, which is rare but is increasingly reported. Due to its ability to mimic more common diagnoses such as chronic inflammatory disorders and malignancies, Basidiobolomycosis imposes a diagnostic challenge on most physicians. Therefore, a timely and correct diagnosis by laboratory tests and careful review of images along with proper medical management can save patients from invasive treatments and reduce both morbidity and mortality. Here, we present a rare case of an 8-year-old boy with basidiobolomycosis initially misdiagnosed as rhabdomyosarcoma. We aim to highlight basidiobolomycosis as a potential differential from masses on imaging under the right clinical circumstances and to provide radiologists with key imaging details to help recognize this infectious etiology and reduce its associated morbidity.
RESUMO
BACKGROUND: There is a growing concern that renal impairment may develop in patients with renal angiomyolipomas (AMLs) associated with tuberous sclerosis complex (TSC) as a consequence of the disease itself and/or the interventions to mitigate the risk of hemorrhage. OBJECTIVE: To assess the estimated glomerular filtration rate (eGFR) in patients with bilateral renal AMLs and the impact of tumor burden and intervention on renal function. DESIGN: Retrospective study. SETTING: Urology department of a tertiary care hospital. PATIENTS AND METHODS: All adult patients (>=18 years of age) with TSC-associated renal AMLs seen from October 1998 to June 2015. We included only patients with bilateral tumors or solitary kidneys at the last follow-up. MAIN OUTCOME MEASURES: The eGFR, renal volume, and number and type of interventions. RESULTS: We identified 12 patients (median age 27.6, interquartile range 23.7-39.9 years), a median follow-up period of 1266 days (33-3133), and a median renal size of 454.7 mL (interquartile range 344.7-1016.9 on the right side; 558.1 mL, interquartile range 253.7-1001.4 on the left). In 11 (91.7%) patients, the eGFR was > 60 mL/min/1.77 m2. Six patients had three total nephrectomies, one had a contralateral partial nephrectomy, and seven had selective arterial embolizations. Intervention was associated with a significantly reduced eGFR. The renal size did not correlate with the eGFR. CONCLUSIONS: TSC-associated renal AMLs may attain a large size but normal renal function is maintained in 92% of patients. Interventions to mitigate the risk of hemorrhage are associated with decreased renal function. LIMITATIONS: The renal size was used as a surrogate for tumor size. Other limitations were the limited number of patients and lack of split renal function testing.