Invasive candidiasis is a major cause of morbidity and mortality in patients with hematologic malignancies and a frequent cause of failure of the initial remission . PURPOSE: To determine if fluconazole is effective treatment for hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine treatment. A second opinion at our institute resulted in the diagnosis of hepatic candidiasis without prior documented candidemia, for which she was treated successfully.

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Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis.

Antibiotic treatment consisted of meropenem, vancomycin, and anidulafungin, which was soon ceased after catheter removal. We feel initial therapy with oral fluconazole for those without severe, systemic symptoms is a reasonable alternative; besides extent and severity of infection, other deciding factors include previous antifungal therapy and culture results, toxicity, and costs. There is little evidence about the optimal treatment, and the optimal duration of treatment likely depends on the level of immunosuppression at the moment of diagnosis as well as the months following diagnosis.

Outpatient treatment with fluconazole mg once daily administered orally was initiated at 21 months. Adults with haematological malignancies and after haematopoietic stem cell transplantation HCT. A second opinion at our institute resulted in the diagnosis of hepatic candidiasis without prior documented candidemia, for which she was treated successfully with fluconazole. Recent evidence strongly suggests that the clinical manifestations of hepatosplenic candidiasis are an example of the immune reconstitution inflammatory condition [ 34 ].

The search yielded hits after removal of 1 duplicate see supplemental online Table.

Additional molecular analysis PCR hepqtosplenic the biopsy was negative for Aspergillus and mycobacteria, and the material was sent to a mycological reference center Radboud University, Nijmegen, The Netherlands for panfungal PCR. Ophthalmic examination revealed no ocular candidiasis. Clin Microbiol Infect ;18 suppl 7: Furthermore, regression of lymphoma masses was seen. Final approval of manuscript: Hepatosplenic candidiasis in patients with acute leukaemia.


candidjasis Case 2 responded well to 3 weeks of intravenous echinocandin treatment followed hepatosp,enic 2 months of fluconazole. Clin Microbiol Infect ; Open in a separate window. Current guidelines and practices for diagnosis and treatment are described. To emphasize the importance of diagnosing HSC without prior documented candidemia, we here present three illustrative cases and a review of the literature on HSC and candidemia.

Hepatosplenic candidiasis is a very unusual clinical syndrome. The Infectious Diseases Society of America advises that treatment should be continued until radiologic lesions are hepatospleinc or resolved, although others define response to treatment as resolution of clinical and biological signs with stable or reduced lesions on imaging [ 8 ], [ 14 ]. Bomers, Karin van Dijk. To investigate to what extent HSC occurs without documented candidemia, we systematically searched the literature for studies that included patients with HSC and documented blood culture results.

The evolving picture of the syndrome.

Liver and spleen are well perfused with good drug penetration when compared with the central nervous system. Joffrey van Prehn, Email: I agree to the terms and conditions. In many cases, the presumptive diagnosis of HSC is based hepatowplenic imaging only, as invasive procedures are not always possible, blood cultures remain negative due to lack of sensitivity or use of empiric antifungal therapy, serologic tests might not be available, and confirmation by biopsy lacks sensitivity due hepatoslenic sampling error [ 8 ], [ 11 ].

Microscopic image of Grocott methenamine silver stain of fine needle aspirate of a liver lesion.

Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis.

Fine needle aspiration biopsy FNAB showed necrosis; tumor necrosis was not ruled out. This limited sensitivity can be partly overcome by taking repeated blood cultures in a neutropenic patient with unexplained or persistent fever. Bomers, Karin van Dijk Provision of study material or patients: Current guidelines and practices for diagnosis and treatment are described. A structured literature search was performed for articles describing any candidlasis with HSC and documented blood culture results.

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Routine blood cell count, inflammation parameters, and renal and liver tests were normal, hepqtosplenic only a mild thrombocytopenia. Additionally, possible fungal hyphae were seen.

A case report and literature survey. In the latter group, HSC as alternative diagnosis for hepatic metastasis should be considered when lesions hepatosllenic not typical for metastasis. Clinical Presentation The cases presented underline that a patient without documented candidemia but with a history of neutropenia may well suffer from HSC.

However, as candieiasis demonstrate in case 2, a positive validated PCR result on a biopsy of normally sterile tissue can confirm the diagnosis. You must accept the terms and conditions.

Surveillance throat cultures were positive for Candida albicans and C.

T o the E ditor— The recently published Infectious Diseases Society of America guidelines for the treatment of hepatosplenic candidiasis includes 3 strong recommendations for intensive and prolonged hepatosplennic of antifungals based on low-quality evidence in addition to a single recommendation to add glucocorticosteroids with a weak recommendation hepatosplfnic based on low-quality evidence [ 1 ].

This is especially important in patients with solid tumors in which candidiasis might be mistaken for metastasis. Author certifies no potential conflicts of interest. Additionally, possible fungal hyphae were seen. The Oncologist published by Wiley Periodicals, Inc. Clin Hepatosplnic Infect ; Two patients underwent successful bone marrow transplantation without relapse of their candidiasis. Hepatosplenic candidiasis HSC often becomes apparent only after neutrophil recovery, adding to the challenge in making the diagnosis [ 5 ], [ 6 ].