Isolated Hepatic Cryptococcosis in an Immunocompetent Child: A Rare Cause of Granulomatous Hepatitis with Cholestasis.

Cryptococcosis is an opportunistic fungal infection acquired through inhalation of Cryptococcus neoformans and is typically encountered in immunocompromised hosts. In children, reported cases most commonly involve the central nervous system or lungs, with hepatic disease usually occurring as part of disseminated infection. Isolated hepatic cryptococcosis in an immunocompetent child is exceptionally rare and provides insight into developmental immune responses in early childhood. We report a young immunocompetent child presenting with fever, hepatomegaly, and cholestatic liver dysfunction. Liver biopsy revealed preserved lobular architecture with prominent portal-based granulomatous inflammation composed of epithelioid histiocytes, multinucleated giant cells, lymphocytes, and eosinophils. Numerous encapsulated yeast forms were identified on routine microscopy and confirmed by mucicarmine staining. Comprehensive clinical evaluation showed no evidence of central nervous system or pulmonary involvement. The well-formed granulomas with relatively contained organisms suggest intact Th1-mediated cellular immunity and effective interferon-γ-driven macrophage activation despite early age. This case highlights the capacity of the developing pediatric immune system to generate organized granulomatous responses and underscores the liver's unique immunologic microenvironment in modulating host-pathogen interactions. Recognition of this rare presentation is critical in the differential diagnosis of pediatric granulomatous hepatitis to facilitate timely antifungal therapy and favorable clinical outcomes.