Abstract
Background: Biliary tract candidiasis is rare and initially diagnosed by culturing bile obtained at operation and/or histological study of the gallbladder at autopsy. We know of no case reports of biliary candidiasis diagnosed by aspiration cytology of gallbladder bile.
Case: A 81-year-old man suffering from fever and anorexia was admitted to our hospital on suspicion of pneumonia. Effective therapy with wide-spectrum antibiotics was started and continued due to remaining slight fever. Due to development of a biliary tract infection with cholelithiasis and endotoxemia, we conducted percutaneous transhepatic puncture of the gallbladder. Cytologically, the gallbadder bile contained numerous fungi with cyanophilic birefringent nonbranching pseudohyphae with budding blastospores. Two thirds of fungi were molded in bile. Fungi were diagnosed as Candida albicans and were the only organisms cultured from the bile. The patient died of biliary tract candidiasis with pneumonia and a hemorrhagic gastric ulcer. Autopsy revealed that cholecystitis with cholelithiasis and fungal balls had developed into systemic candidiasis.
Conclusion: This report describes a case of biliary tract candidiasis probably following gram-negative bacterial infection, which developed into systemic candidiasis. Longstanding administration of wide-spectrum antibiotics and cholestasis with cholelithiasis predisposed the patient to biliary tract candidiasis, which invaded through the alimentary tract. Aspiration cytology of the bile was thus found to be useful in rapidly diagnosing biliary tract candidiasis.
