Biliary candidiasis mimicking IgG4‐related disease in a patient with normal immunity

Abstract

Abstract Purpose To report a rare case of biliary candidiasis in a host with normal immunity. Methods Laboratory tests indicated an elevated G level of 1000 pg/ml. Microscopic examination of pathological sections demonstrated multiple, narrow base, budding yeast cells following Grocott's methenamine silver staining and periodic acid‐Schiff staining. Subsequent sequence analysis supported the diagnosis of biliary candidiasis. Results A 31‐year‐old previously healthy man developed obstructive jaundice under no obvious inducement. He experienced cholecystectomy and biliary drainage. Surgical specimens revealed granulomatous chronic inflammation in the gallbladder, liver, bile ducts and mesenteric lymph nodes. He was misdiagnosed with tuberculosis and received antituberculosis treatment. However, his condition did not improve. He was finally diagnosed with biliary candidiasis and administered the antifungal treatment with fluconazole. His symptoms improved after such treatment. Conclusions We reported a case of biliary candidiasis that mimicked IgG4‐RD in a host with normal immunity. Our findings highlighted the need for pathological diagnosis in patients with symptoms resembling IgG4‐RD.

Keywords

• biliary candidiasis
• IgG4‐RD
• opportunistic pathogen