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Visualizing Non-lytic Exocytosis of Cryptococcus neoformans from Macrophages Using Digital Light Microscopy

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Cholangitis associated with Cryptococcus neoformans.

J C Bucuvalas, K E Bove, R A Kaufman

Gastroenterology

|April 1, 1985

Summary

A pediatric patient with presumed primary sclerosing cholangitis was diagnosed with a rare opportunistic biliary infection. This case highlights the importance of considering fungal infections in pediatric cholangitis.

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Published on: March 19, 2015

Area of Science:

Medical Mycology
Hepatology
Pediatric Gastroenterology

Background:

Primary sclerosing cholangitis (PSC) is a chronic liver disease characterized by bile duct inflammation and fibrosis.
Pediatric PSC can present with varied symptoms, including abdominal pain and jaundice.
Opportunistic infections are a concern in immunocompromised individuals, but can also occur in seemingly immunocompetent hosts.

Observation:

A 15-year-old female presented with right upper quadrant pain and jaundice, initially suspected to be PSC.
Diagnostic workup revealed elevated alkaline phosphatase, signs of portal hypertension, and CT scan findings consistent with PSC.
Intraoperative bile and common bile duct cultures unexpectedly identified *Cryptococcus neoformans*.

Findings:

The patient received amphotericin B for the fungal infection.
Complications, including upper gastrointestinal bleeding and hepatorenal syndrome, led to a fatal outcome.
Autopsy confirmed active sclerosing cholangitis coexisting with cryptococcal infection in the common bile duct.

Implications:

This case suggests that opportunistic biliary infections, such as cryptococcosis, should be considered in the differential diagnosis of pediatric patients presenting with symptoms suggestive of PSC.
Early recognition and treatment of fungal cholangitis may improve patient outcomes.
Further research is needed to understand the pathogenesis and optimal management of fungal infections in the biliary tree of pediatric patients.