Isolated Hepatic Cryptococcosis in an Immunocompetent Child: A Rare Cause of Granulomatous Hepatitis with Cholestasis.
Kala Gnanasekaran Kiruthiga, Kinisha Patel, Ashish Bavdekar et al.
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Case in brief
A young immunocompetent child presented with fever, hepatomegaly, and cholestatic liver dysfunction. Liver biopsy showed preserved lobular architecture and prominent portal-based granulomas containing epithelioid histiocytes, multinucleated giant cells, lymphocytes, and eosinophils. Numerous encapsulated yeasts were seen on routine microscopy and confirmed with mucicarmine staining, supporting hepatic cryptococcosis. Clinical evaluation found no pulmonary or central nervous system involvement, establishing an isolated hepatic presentation. The report describes the case as a rare cause of granulomatous hepatitis with cholestasis in an immunocompetent child.
What made this case unusual
The child had isolated hepatic cryptococcosis despite being immunocompetent; hepatic disease is usually reported with disseminated infection, while pediatric cases more commonly involve the lungs or central nervous system.
Diagnostic / clinical pearl
In a child with granulomatous hepatitis and cholestasis, consider cryptococcosis and use tissue morphology with mucicarmine staining to identify encapsulated yeasts; assess for pulmonary and central nervous system involvement.