A novel treatment of candidal cholecystitis using amphotericin B cholecystostomy irrigation
Shalini R. Anne MD, Peter L. Faries MD, and Gregg S. Landis MD
The authors report in the August, 2006 edition of Surgical Rounds the case of a 33 year old man who sustained multiple stab wounds to his abdomen with multiple injuries and gross spillage of enteric contents. The patient developed multiple sites of bacterial infection in his abdomen and from his central
access and was treated with multiple antibiotics.
On postoperative day 35 he showed repeat signs of sepsis and fungal blood cultures for Candida parapsilosis were positive and the patient was started on amphotericin B. At this time he also developed on ultrasound pericholecystic fluid and gallbladder wall thickening consistent with acalculous cholecystitis. A cholecystostomy tube was placed to drain the gallbladder and bile cultures were returned positive for Candida parapsilosis.
Despite a 10 day course of amphotericin B, the patient’s blood and bile cultures continued to be positive. In an attempt to eradicate the suspected gallbladder source of the fungal infection, amphotericin B was instilled into the gallbladder via the cholecystostomy tube three times a day for 7 days. By day 5 of this treatment the patient’s sepsis had resolved and the blood and bile cultures were negative. The patient expired two months later of unrelated pulmonary complications.
Editor’s discussion: Fungal infections of the biliary tree are uncommon, occuring in an estimated 0.01% of hospitalized patients. If the fungal infection is isolated to the gallbladder, cholecystectomy is considered curative. However, some patients with fungal gallbladder infections are too unstable for cholecystectomy. The technique used by the authors in this case report is an adaptation of the strategy of treating fungal infections of the urinary bladder with topical amphotericin B irrigations.