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

Abstract

Cryptococcus neoformans and Candida are common opportunistic pathogens of human. There is very limited literature on Cryptococcus neoformans cholangitis or Candida cholangitis in immunocompetent patient while mixed Cryptococcus neoformans and Candida cholangitis has not been reported in the literature ever before. We hereby report the imaging findings of a case of mixed Cryptococcus neoformans and Candida cholangitis in an immunocompetent boy. The CT features included nodules in the cystic duct and common bile duct, dilatation of the intra-and extrahepatic bile ducts with mural thickening, irregular hypodense mass-like lesion extending along the bile ducts from the liver hilum to the periphery which was confirmed by the presence of enlarged and confluent lymph nodes. CT characteristics can contribute to timely diagnosis and treatment of this disease.

Fungal-Bacterial Interactions in Health and Disease

“…Bacteria that are often co-isolated with Candida spp. from infection sites are staphylococci [10,316], but also less frequent bacteria such as S. marcescens , Tropheryma whipplei or other fungi, for example, C. neoformans [317,318,319].…”

A Rare Case of Biliary Cryptococcosis Clinical Pharmacist Participation in Treatment and Pharmaceutical Care and Literature Review

“…Fluconazole for 8weeks. / (Luo et al, 2014) 4 5 M Upper abdominal pain, jaundice, mild hepatosplenomegaly CT showed CBD with incomplete bile duct obstruction. Ultrasound demonstrated irregular mural thickening of the CBD.…”

Liver and Bile Duct Infections

“…[404][405][406] In contrast, immunocompetent patients tend to present with an isolated biliary infection that clinically and radiologically mimics sclerosing cholangitis or cholangiocarcinoma. [407][408][409][410][411][412] These patients exhibit obstructive jaundice, and radiologic studies may show dilatation of intrahepatic bile duct dilatation, stricturing and wall thickening of extrahepatic bile ducts, and masslike lesions in the hilum. Most reported immunocompetent patients with biliary cryptococcosis are children or young adults.…”

“…Most reported immunocompetent patients with biliary cryptococcosis are children or young adults. [407][408][409]412 Histopathologically, immunocompetent cases are characterized by granulomas, whereas in AIDS patients, an inflammatory reaction is poorly developed or absent. Autopsies in cases of disseminated infection have shown areas of necrosis with innumerable yeast cells, yeast cells diffusely within tissue admixed with cellular debris and inflammation, or yeast cells within Kupffer cells ( Fig.…”