Image of the quarter: An unusual cause of obstructive jaundice

Cryptococcus neoformans is an opportunistic fungal infection that mainly affects immunocompromised patients with or without HIV and can only be seen infrequently in the immunocompetent host. Presentation can be with pneumonia, meningitis  or  widely  disseminated  disease. We  report  the  case  of  a  65-year-old man  who  presented  with  obstructive  jaundice  and  weight  loss.  He  had  been evaluated at another institution where surgery was offered to him for a presumed diagnosis  of  cholangiocarcinoma.  Our  evaluation  revealed  disseminated  crypto-coccal infection for which the patient received fluconazole for six months, which resulted in the resolution of his obstructive jaundice.