Fungal liver abscess in an immunocompetent patient who underwent repeated ERCPs and subtotal cholecystectomy

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.

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