Bronchobiliary fistula secondary to hepatic malignancy with Exophiala dermatitidis infection: a case report.

BACKGROUND: Bronchobiliary fistula (BBF) is a rare but severe complication following the treatment of hepatic malignancies. Exophiala Dermatitidis(E. Dermatitidis), a dematiaceous fungus, is an opportunistic pathogen that predominantly affects immunocompromised individuals. However, its role in BBF-associated infections has not been previously documented. CASE PRESENTATION: A 79-year-old man who was diagnosed with metastatic hepatic malignancy three years prior presented with a fever that persisted for seven days and dyspnoea for two days; a comprehensive evaluation was initiated on admission. Bronchoscopy revealed the presence of BBF, and imaging revealed hepatic and subphrenic abscesses. Ultrasound-guided drainage of the hepatic abscess was performed, and both the abscess aspirate and bronchoalveolar lavage fluid yielded E. dermatitidis on culture. Based on the clinical and microbiological findings, a diagnosis of BBF-related E. dermatitidis infection was established. The patient was treated with voriconazole (VRCZ) in conjunction with drainage. Antimicrobial therapy achieved the remission of symptoms, and the patient was discharged. Five months later, the disease recurred, necessitating readmission. Given the end-stage malignancy, profoundly poor performance status, and dismal prognosis, after exhaustive discussion, the family opted to forgo further active treatment. CONCLUSIONS: This case highlights for the first time that BBF may serve as a unique conduit for the dissemination of E. dermatitidis, underscoring the importance of considering rare pathogens in patients with hepatic abscesses complicated by pulmonary infections. A prompt microbiological evaluation and targeted antifungal therapy are essential for optimal outcomes. CLINICAL TRIAL: This article is a case report; therefore, I declare that a clinical trial number is not applicable.