Aspergillus cholangitis: A late complication after Kasai portoenterostomy

Ascending bacterial cholangitis can be a recurring complication in older children and adolescents who have undergone successful surgery for biliary atresia. The authors describe a 19-year-old girl with a history of recurrent late-onset, febrile cholangitis in whom persistent jaundice developed. Aspergillus terreus was isolated from her biliary fluid obtained at percutaneous transhepatic cholangiography. Despite prolonged external biliary drainage and systemic amphotericin B therapy, the fungus was not eliminated from her biliary system. Aspergillus cholangitis can occur in the portoenterostomy patient and may be highly resistant to conventional therapy.