Patel S A, Borges M C, Batt M D, Rosenblate H J
Lutheran General Hospital, Park Ridge, Illinois.
Am J Gastroenterol. 1990 Jan;85(1):84-7.
Usually, ascending cholangitis is a bacterial process. However, in the debilitated or immunocompromised patient, mycotic cholangitis must be placed in the differential diagnosis. We report a patient with cryptogenic cirrhosis whose presenting problem in his terminal hospitalization was spontaneous bacterial peritonitis, for which he was treated with broad-spectrum antibiotics. Endoscopic retrograde cholangiopancreatogram was performed during the hospital course to explain his profound hyperbilirubinemia. The findings were grossly consistent with primary sclerosing cholangitis or cholangiocarcinoma. The patient subsequently continued to deteriorate, and died with hepatic and renal failure. At autopsy, he was found to have choledocholithiasis, marked biliary duct proliferation, and ascending cholangitis, with Trichosporon demonstrated histologically to be invading the bile ducts. To our knowledge, this is the first reported case of Trichosporon cholangitis.
通常，化脓性胆管炎是一个细菌感染过程。然而，对于身体虚弱或免疫功能低下的患者，霉菌性胆管炎必须列入鉴别诊断。我们报告一例隐源性肝硬化患者，其临终住院时的主要问题是自发性细菌性腹膜炎，为此接受了广谱抗生素治疗。在住院期间进行了内镜逆行胰胆管造影，以解释其严重的高胆红素血症。检查结果与原发性硬化性胆管炎或胆管癌大致相符。该患者随后病情持续恶化，最终死于肝肾功能衰竭。尸检发现，他患有胆总管结石、明显的胆管增生和化脓性胆管炎，组织学检查显示白吉利丝孢酵母侵入胆管。据我们所知，这是首例报告的白吉利丝孢酵母性胆管炎病例。
