Common bile duct obstruction due to candidiasis

Area of Science:

• Gastroenterology
• Infectious Diseases
• Mycology

Background:

• Biliary obstruction is common, with diverse causes like malignancy and gallstones.
• Fungal infections of the biliary tract are exceptionally rare, despite increasing recognition in predisposed individuals.

Observation:

• A patient with a history of prolonged mechanical ventilation presented with cholangitis and distal common bile duct stenosis, initially suspected as malignancy.
• Subsequent endoscopic retrograde cholangio-pancreatography revealed a beaded appearance of the bile ducts, indicative of chronic secondary sclerosing cholangitis.
• A filamentous Candida conglomerate was extracted from the bile duct, confirmed by histological and microbiological analysis.

Findings:

• The study identified Candida colonization as the cause of biliary obstruction and secondary sclerosing cholangitis.
• Histological examination confirmed a Candida conglomerate within the bile duct system.
• Microbiological analysis of bile aspirates verified Candida colonization.

Implications:

• This case underscores the rare but critical possibility of fungal involvement in biliary tract diseases, particularly in immunocompromised or critically ill patients.
• It emphasizes the need for a broad differential diagnosis in biliary obstruction, including fungal etiologies.
• The findings contribute to understanding the pathogenesis of fungal-induced cholangitis and sclerosing cholangitis.