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13 May 2019 : Case report  United Arab Emirates

Fungal Peritonitis with Fungus Balls, a Complication of Trichobezoars and Rapunzel Syndrome

Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care

Ehsan Sotoudeh1ABCDEF, Shabbir Hussain2ABD, Omid Shafaat3E, Houman Sotoudeh4BEF

DOI: 10.12659/AJCR.915517

Am J Case Rep 2019; 20:685-688


BACKGROUND: Rapunzel syndrome is a rare condition involving the extension of bezoars from the stomach to the distal gastrointestinal tract. Laparotomy remains the gold standard treatment for this condition because of the size of the bezoars. Although bacterial peritonitis is a known complication of laparotomy in Rapunzel syndrome, very few cases of post-surgical fungal peritonitis have been reported in these patients.

CASE REPORT: In this case report we present Rapunzel syndrome complicated by post-surgical fungal peritonitis and formation of fungus balls. To our knowledge, fungal peritonitis with fungus balls has never been reported as a Rapunzel syndrome complication. 

CONCLUSIONS: It is important to cover Candida and other fungi with an antifungal regimen in pediatric patients with Rapunzel syndrome pre- and post-surgery. In addition, prolonged fever and septic symptoms post-surgery warrant a search for peritoneal fungus balls that are not simply responsive to anti-fungal therapy and may necessitate repeat laparotomy.

Keywords: Bezoars, Fungi, peritonitis, Candidiasis, Child, Intestinal Obstruction, Stomach, Tomography, X-Ray Computed

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923