Fungal liver abscesses in an immunocompetent patient post cholecystectomy – a case report

Abstract

Candida albicans is known to colonise the biliary tract but rarely causes invasive candidiasis post gastrointestinal or hepatobiliary surgery in the absence of host immunosuppression. This case study reports a 33-year-old immunocompetent female with a past surgical history of sleeve gastrectomy, omega loop (mini) gastric bypass and gastric ulcer repair. Two weeks post laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) the patient presented with right upper quadrant abdominal pain, rigors, nausea, vomiting, fevers (39.5 degrees) and tachycardia. Liver function tests were mildly deranged, the white cell count was 10×109/L and the C-reactive protein was elevated at 327 mg/L. Computed tomography (CT) revealed multiple right lobe liver abscesses and mild splenomegaly. The patient underwent ultrasound guided drainage and Candida albicans was subsequently grown from the aspirate sample. After a 4-week course of oral fluconazole, a repeat CT abdomen and pelvis showed good resolution with 3-4 remaining small liver collections. An abdominal ultrasound 8-weeks post initial presentation showed complete resolution and subsequent gastroscope, echocardiogram and ophthalmological examination were unremarkable. Although liver abscesses caused by Candida albicans rarely occur in immunocompetent patients, it should be included in the differential diagnosis in such patients presenting with suspicious features post laparoscopic cholecystectomy and IOC.