A case of obstructive jaundice due to deep mycoses

A 31-year-old man was admitted to our hospital with complaint of jaundice, and he had been suffering from a ringworm infection of Trichophyton rubrum for one year. On admission, obstructive jaundice was seen. ERCP revealed irregular filling defect in the common bile duct and dilatation of the intrahepatic duct. At exploratory laparatomy, many swelling lymphnodes were revealed adhering the common bile duct. Their histology were granulomas with necrotic tissue, and PAS stain positive, many septate mycelial fragments were observed in the center of the lymphnodes. Lymphnodes were resected surgicaly followed by compress of griseofulvin. But, inspite of the therapy of T-tube drainage and other antimycotic drug, the patient has been persistent jaundice and the histology of liver was revealed biliary cirrhosis. It seems quite rare to experience such obstructive jaundice due to the external obstruction of the common bile duct by the granulomatous lymphnodes, which were probably formed by lymphogenous infection after suffering from a ringworm infection of the skin.