Hepatic mucormycosis mimicking hilar cholangiocarcinoma: a case report and literature review

Abstract

Mucormycosis is a rare but invasive opportunistic fungal infection associated with a high mortality rate, and normally occurs in immunocompromised patients. In this report, we describe an immunocompetent patient suffering from hepatic mucormycosis secondary to adrenal mucormycosis, which masquerades as hilar cholangiocarcinoma. After surgical procedure and treatment with amphotericin B and itraconazole, the patient recovered well and had a 2-year infection-free survival. To our knowledge, this special clinical manifestation of hepatic infection as well as adrenal mucormycosis has not been reported to date. Meanwhile, this is the first case of an immunocompetent patient with both adrenal and hepatic mucormycosis who has been treated successfully.

Figure 1

Adrenal mucormycosis, grocott methenamine sliver stain, × 100.

Figure 2

Imaging changes. A: Arrow shows computed tomography (CT) features of adrenal mucormycosis; B: CT features of hepatic lesion. A well circumscribed hypodense lesion in hilar and left lateral lobe, surrounding the vessels without a mass effect, should suggest an angioinvasive organism. This lesion presents necrosis of liver tissue due to fungal thrombosis; C: Magnetic resonance cholangiopancreatography demonstrates an abrupt stenosis of the primary biliary confluence with symmetric upstream dilation of the intrahepatic bile ducts.

Figure 3

Cut surface of the liver mass, a yellowish-white tissue. Vessels are present in mass. Arrow shows intrahepatic bile ducts dilatation, thickening and cholestasis.

Figure 4

Pathological changes of liver tissue. Inflammatory focus containing irregularly shaped, broad, nonseptate hyphae with right angle branching typical of mucormycosis. A: Hematoxylin and eosin stain, × 40; B: Grocott methenamine sliver stain, × 100.