Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

Abstract

We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.

Diagnostic and post-treatment CT appearance of biopsy proven mixed cryptococcus and candida cholangitis

“…Similar to Cryptococcus cholangitis, the bile ducts are markedly dilated, as seen in this case. One man recovered after resection of the lesion without any anti-fungal treatment and the outcome was not reported on two patients [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Our patient showed similar CT features as Cryptococcus cholangitis reported in previous literature including common bile duct dilatation progressing to mural thickening and stenosis, hepatic portal and retroperitoneal lymphadenopathy, and a hypodense confluent lymph node mass extending from the porta hepatis to the periphery.…”

“…Lymphadenopathy was reported in 3/12 patients with biliary Cryptococcus infection [5][6][7]. Compared to Cryptococcus, Candida cholangitis is even less common and afflicts immunocompromised host with only five cases reported in immunocompetent patients [17][18][19][20][21]. These features mimic imaging characteristics seen in biliary malignancy and primary sclerosing cholangitis.…”

“…A low-density mass in the hepatic portal area was reported in two cases [5,16]. Patients therefore often present with symptoms suggestive of biliary colic [17,18,21]. Compared to Cryptococcus, Candida cholangitis is even less common and afflicts immunocompromised host with only five cases reported in immunocompetent patients [17][18][19][20][21].…”

“…Compared to Cryptococcus, Candida cholangitis is even less common and afflicts immunocompromised host with only five cases reported in immunocompetent patients [17][18][19][20][21]. Therefore, even though it is extremely rare, mixed fungal cholangitis should still be considered as one of the differential diagnosis when the imaging features mentioned previously occur, This should be considered along with cholangiocarcinoma, lymphoma, primary sclerosing cholangitis and inflammatory pseudotumor when considering the differential diagnosis of bile duct dilatation and mural thickening [5,[15][16][17][18][19]21]. Patients therefore often present with symptoms suggestive of biliary colic [17,18,21].…”

“…Common bile duct obstruction is a common finding in 4/5 of the reported cases, possibly because of the formation of fungal balls [20]. Before definite diagnosis is made, broad-spectrum antimicrobial should be initiated to control patient's symptoms and as a diagnostic therapy [5,18]. However, bile duct mural thickening, lymphadenopathy and low-density mass have not been previously reported in other cases of Candida cholangitis.…”