Isolated hepatobiliary cryptococcosis manifesting as obstructive jaundice in an immunocompetent child: case report and review of the literature

Eur J Pediatr. 2014 Dec;173(12):1569-72. doi: 10.1007/s00431-013-2132-2. Epub 2013 Aug 14.

Abstract

The majority of patients with symptomatic cryptococcosis have an underlying immunocompromising condition. In the absence of coexisting immunocompromising condition, Cryptococcus neoformans is rarely considered in the differential diagnosis of obstructive jaundice that occurs in children with hilar masslike lesion. Here, we report a 5-year-old boy without immunoglobulin or lymphocyte abnormalities who developed a hepatobiliary infection with C. neoformans. Ultrasonography and computed tomography showed dilatation of the bilateral intrahepatic bile ducts and a low-attenuated mass in the hepatic hilum. Microscopic examination of tissue samples revealed abundant numbers of encapsulated yeast cell suggestive of C. neoformans. After 4 months of antifungal therapy (liposomal amphotericin B for 2 weeks and oral fluconazole for 3 months), the disease was effectively controlled. Unnecessary operation could be avoided by an early and accurate diagnosis. By sharing our experience, we suggest hepatobiliary surgeons and gastroenterologists should have a suspicion of this unusual entity to make earlier diagnosis and treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Bile Duct Diseases / complications
  • Bile Duct Diseases / diagnosis*
  • Bile Duct Diseases / immunology
  • Bile Duct Diseases / microbiology
  • Bile Ducts, Intrahepatic / microbiology*
  • Child, Preschool
  • Cryptococcosis / complications
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / immunology
  • Cryptococcus neoformans / isolation & purification*
  • Humans
  • Immunocompetence*
  • Jaundice, Obstructive / microbiology*
  • Liver Diseases / complications
  • Liver Diseases / diagnosis*
  • Liver Diseases / immunology
  • Liver Diseases / microbiology
  • Male