Table 2.
Clinical Characteristics of Bile Duct Cryptococcosis
| References | Age | Gender | Presenting Symptoms | General Examination | Laboratory Methods | Other Sites Involve | Therapy | Prognosis/Time |
|---|---|---|---|---|---|---|---|---|
| (Kumar et al, 2019)2 | 49 | M | High-colored urine, yellowish discoloration of eyes, pale stools, itchy skin, fever, nausea, vomiting, headache | Scleral icterus, moderate hepatomegaly, ERCP showed CHD. | Bile aspirate smears displayed cryptococcosis, | Blood, CSF | Antifungal, antitubercular, antiretroviral | Died/ 1 month |
| (Burad and Ramakrishna, 2017)3 | 48 | F | Lower back pain, low-grade fever, and an evening rise, yellowing of the eyes and urine | Ultrasound showed hepatomegaly, dilated CBD. CT, EUS showed CBD stricture with a thickened wall. |
The cytology smears suggested cryptococcosis. | Blood, CSF, sputum, vertebra, skin | Amphotericin-B,14days. Fluconazole for 8weeks. | / |
| (Luo et al, 2014)4 | 5 | M | Upper abdominal pain, jaundice, mild hepatosplenomegaly | CT showed CBD with incomplete bile duct obstruction. Ultrasound demonstrated irregular mural thickening of the CBD. | CBD biopsied showed fungal hyphae. Alcian stain for the capsule of C.neoformans was positive. |
/ | Flucomazole,400 mg/d, po | Normal/10 months |
| (Zhang et al, 2014)5 | 5 | M | Low-grade intermittent fever, jaundice, dark urine, clay-colored stool. | Ultrasonography revealed intrahepatic biliary dilatation. CT scan produced a slight irregular peripheral enhancement and a central area of lower attenuation. | Microscopic examination revealed multinucleated giant cells, cuboidal bodies of C.neoformans | NOT | Liposomal amphotericin B, 2 weeks. Fluconazole for 3 months. | Normal/4 months |
| (Cai et al, 2012)6 | 44 | F | Right upper quadrant discomfort and jaundice, icteric eyes and skin with darkened urine, nauseous, colicky pain in the stomach and back | Ultrasonography revealed extra and intrahepatic dilatation. The outer CBD was dilated but the lumen was narrowed. Contrast-enhanced CT scan and an MRCP produced a hilar biliary stricture. |
CBD frozen section samples demonstrated cryptococcosis. Microscopic examination, the periodic acid methenamine silver stain, periodic acid Schiff stain and India ink stain positive. PCR identified pathogen was C. neoformans | NOT | Itraconazole, IVGTT,2 weeks then 10 weeks po | Normal/4 weeks |
| (Pastagia and Caplivski, 2010)7 | 29 | F | Fever, abdominal pain, vaginal bleeding, | Abdominal imaging revealed gallbladder wall thickening with pericholecystic fluid. | Mucicarmine stain revealed Cryptococcus. Biochemical identification, Molecular sequencing revealed C. neoformans. Serum cryptococcal antigen titer 1:512. | Lungs, placenta | Liposomal amphotericin B +flucytosine. Fluconazole | Normal/2 months |
| (Nara et al, 2008)8 | 25 | M | Upper abdominal pain, jaundice, | Enhanced CT scan showed bilateral intrahepatic bile duct dilatation. Cholangiogram showed complete obstruction at the hepatic confluence and irregularity of the left hepatic duct. | Liver mass biopsy showed liver cryptococcosis. Bile and biopsy specimens’ culture, periodic acid Schiff (PAS), Grocott stains showed C. neoformans. Serum Cryptococcus neoformans antigen was positive. | Lungs | Flucomazole,400 mg/d, po,12 months | Normal / 8 months |
| (Singh et al, 2007)9 | 65 | F | Anorexia, nausea, vomiting | Abdominal sonogram demonstrated cholecystitis and cholelithiasis. | Gallbladder biopsy and washings, Blood cultures showed cryptococcus. serum cryptococcal antigen titers were greater than 1:512. | Spinal/cerebrospinal fluid | / | / |
| (Das et al, 2006)10 | 5 | M | High-grade intermittent fever, progressive jaundice, dark urine, clay-colored stool. | Ultrasonography revealed dilatation of intrahepatic biliary. MR and MRCP performed the bile-duct wall thickening and severity of biliary obstruction. | Liver biopsy revealed canalicular cholestasis. Cytological mucicarmine stain of the bile duct wall revealed cryptococcus. | NOT | Amphotericin B, 10 weeks. Fluconazole | Improvement/ 6 weeks |
| (Goenka et al, 1995)11 | 7 | M | High fever, jaundice, pruritus | Ultrasound showed dilatation of intrahepatic biliary. ERCP showed complete block in the CBD. | Liver biopsy showed extrahepatic biliary obstruction. Multiple cryptococci were seen in parenchyma and portal area. | Disseminated | Amphotericin B, with 5-flucytosine | Liver and splenomegaly/ 16 months |
| (Bucuvalas et al, 1985)12 | 15 | F | Right upper quadrant discomfort and jaundice. | Ultrasound, CT showed biliary dilation and a thickened CBD. Intraoperative cholangiogram demonstrated severe stenosis of proximal radicles and obstruction at the cystic duct. | Gram stain of bile, Cultures of the bile and CBD grew C. neoformans. | Urine, blood | Amphotericin B | Improvement/15 days |