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CASE REPORT
Fungal liver abscess in an immunocompetent patient who underwent repeated ERCPs and subtotal cholecystectomy
  1. Sundas HASAN1,
  2. Robert FEARN2
  1. 1Department of Acute Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
  2. 2Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sundas HASAN, sundas_hasan{at}hotmail.com

Summary

We report a case of a previously healthy female patient who initially presented with fever, jaundice and right upper quadrant pain three days after dilatation and stenting of a stricture of the common bile duct (CBD). During an earlier admission, the patient had undergone endoscopic retrograde cholangiopancreatography (ERCP) having presented with fevers and biliary dilatation on ultrasound. The ERCP features were more consistent with Mirizzi’s Syndrome. The patient subsequently underwent subtotal cholecystectomy and later developed a CBD stricture, requiring repeat ERCP and stent insertion. At presentation, she had moderately deranged liver function tests and significantly elevated inflammatory markers and was found on cross-sectional imaging to have developed a liver abscess. Aspiration of the lesion cultured Candida albicans. She was treated with intravenous antifungals, broad-spectrum antibiotics and further aspiration of abscess, which contributed towards her successful recovery. Fungal liver abscess should be suspected in immunocompetent patients who undergo ERCP and or cholecystectomy.

  • biliary intervention
  • gi-stents
  • endoscopy
  • pancreas and biliary tract
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Footnotes

  • Contributors SH felt that this case is unique and did the literature search to affirm her idea. SH consented the patient and drafted initial format of the case report including discussion and incorporated the references. RF is the supervisor consultant who scrutinised the study, evaluated it critically and contributed two important references in the discussion. He also advised regarding the selection of suitable images and helped formulate the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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