title: Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer.
abstract: Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in biliary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly difficult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.
authors.affiliation: Department of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98101, USA. brian.story@vmmc.org
authors.forename: Brian
authors.initials: B
authors.lastname: Story
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery; D002761:Cholangitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D015607:Stents
chemical_list: D000935:Antifungal Agents