Echinococcal Cyst of the Liver Primarily Infected with Candida glabrata

The main complications of hepatic hydatid disease are infection and rupture into the biliary tree or into the peritoneal cavity. Fungal infections within the biliary tract and the liver are very rare, whereas cases of hepatic echinococcal cysts infected by fungi have not been previously reported.

We report on a 63-year-old male patient with a 3-day history of dull, non-radiating pain in the right hypochondrium, low-grade fever, and malaise. His past medical history included a Roux-en-Y hepatico-jejunostomy and gastro-enteroanastomosis for locally extended adenocarcinoma of the intra-pancreatic common bile duct. Laboratory analyses showed elevated WBC and C-reactive protein levels. The computed tomography scan showed an infected hydatid cyst grade CE5 according to Gharbi's and WHO classifications. Catheterization was performed, and cultures revealed Candida glabrata. Anidulafungin was initiated with a loading dose of 200 mg, followed by a daily dose of 100 mg. After 23 days, cultures of the draining fluid showed no fungi or other bacteria. Two days later the catheter was removed, the patient was discharged, and at the time of follow-up at 1 and 2 months, remained well.

Fungal infections should be considered in patients with an infected echinococcal cyst of the liver. Understanding of the etiology and epidemiology, along with early and rapid detection of C. glabrata, is necessary for prompt treatment.