Left hepatectomy for oriental cholangiohepatitis

Our patient was a young male with a large solitary liver abscess. Amoebic liver abscess would have been the expected clinical diagnosis with this presentation. However amoebic serology was negative and the cultures from the abscess cavity repeatedly grew Candida albicans without any sign of bacterial growth, thus leading us to the diagnosis of a Candidial liver abscess. The gastrointestinal tract appears to be the probable source of the Candida infection in this patient. To the best of our knowledge, this is only the second instance of a fungal liver abscess reported in an immunocompetent host. In an earlier report Candida glabrata liver abscess was discovered in a 64-year-old female, but that patient had chronic obstructive pulmonary disease and had received multiple antibiotics as well as short duration steroid therapy. In contrast our patient did not have any long standing illness and had never been on any immunosuppressant medication. Most hepatic fungal abscesses occur in patients with hematological malignancies and are caused by Candida albicans. Marcus et al, observed that 19 of 20 fungal abscesses in cancer patients were caused by Candida albicans. Fifteen of them had hematologic malignancies. The patient responded to fluconazole. The current IDSA clinical practice guidelines on the management of candidiasis also recommend fluconazole as the initial therapy for invasive candidiasis caused by C. albicans in non-neutropenic adults. The fact that the patient was immunocompetent may have some bearing on the unusual clinical presentation and excellent response to treatment that was seen in this patient. Our report suggests that it will be prudent to exclude fungal infections in case the bacterial cultures are sterile from a pyogenic abscess as attempts to treat can be quite rewarding.