Numan Laith, Hayajneh Wail A, Kiwan Wissam
Division of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO.
Division of Pediatric Infectious Diseases, Saint Louis University, Saint Louis, MO.
ACG Case Rep J. 2023 Oct 3;10(10):e01173. doi: 10.14309/crj.0000000000001173. eCollection 2023 Oct.
Gastrointestinal manifestations in systemic fungal infection are not uncommon; however, obstructive jaundice due to lymphadenopathy is considered rare. We present a case of a 16-year-old male patient who presented with painless jaundice. Laboratory tests revealed direct hyperbilirubinemia with cholestatic liver injury. Chest and abdominal computed tomography showed mediastinal and porta hepatis lymphadenopathy, with severe biliary ductal dilatation proximal to an obstructing lymph node near the head of the pancreas. Endoscopic ultrasound showed a 22 × 35-mm lymph node with a mass effect on the common bile duct leading to obstructive jaundice. Infectious workup confirmed the diagnosis of disseminated histoplasmosis.
胃肠道表现于系统性真菌感染中并不罕见；然而，因淋巴结病导致的梗阻性黄疸被认为较为罕见。我们报告一例16岁男性患者，其表现为无痛性黄疸。实验室检查显示直接胆红素血症伴胆汁淤积性肝损伤。胸部和腹部计算机断层扫描显示纵隔和肝门淋巴结病，在胰腺头部附近的一个梗阻性淋巴结近端有严重的胆管扩张。内镜超声显示一个22×35毫米的淋巴结，对胆总管有肿块效应，导致梗阻性黄疸。感染性检查确诊为播散性组织胞浆菌病。
