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: successful treatment with fluconazole.

Clin Microbiol Infect ;18 suppl 7: Loss of integrity of intestinal mucosa in combination with prednisone may have contributed to Candida seeding in this patient. Panfungal PCR result was positive, and subsequent sequencing indicated presence of C.

Fine needle aspiration biopsy FNAB showed necrosis; tumor necrosis was not ruled out. A structured literature search was performed for articles describing any patient with HSC and documented blood culture results.

During this period, he underwent a hemicolectomy for a pT3N0 colon carcinoma. Prior therapy with 1. Moreover, a scheduled hemihepatectomy was prevented. Microscopic image of Grocott methenamine silver stain of fine needle aspirate of a liver lesion.

Hepatosplenic candidiasis: successful treatment with fluconazole.

In many cases, HSC becomes apparent only after neutrophil recovery [ 5 ], [ 6 ]. This might prevent unnecessary surgery or inappropriate treatment. Bomers, Karin van Dijk Manuscript writing: Routine blood cell count, inflammation parameters, and renal and liver tests were normal, with only a mild thrombocytopenia.

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Ultrasound imaging showed no focal liver lesions, but subsequent magnetic resonance imaging MRI revealed hepatosplenomegaly and multiple T2 hyperintense lesions Fig.

The European Society for Clinical Microbiology and Infectious Diseases recommends the following investigations as essential for the diagnosis of chronic disseminated candidiasis: HSC is not strictly limited to hematologic patients and might also occur in patients with solid tumors treated with intensive chemotherapy or SCT.

Hwpatosplenic Microbiol Rev ; Antifungal therapy should be continued throughout additional chemotherapy courses or SCT to prevent relapse [ 14 ].

In the latter group, HSC as alternative diagnosis for hepatic metastasis should be considered when lesions are not typical for metastasis.

Antibiotic treatment consisted of meropenem, vancomycin, and anidulafungin, which was soon ceased after catheter removal. Meanwhile, an MRI 2 weeks after start of candidiasjs antimicrobial treatment showed a decrease of the hepatic lesions Fig.

Clin Microbiol Infect ; Crit Care Med ; Close mobile search navigation Article navigation. Ultrasound imaging showed no focal liver lesions, but subsequent hepztosplenic resonance imaging MRI revealed hepatosplenomegaly and multiple T2 hyperintense lesions Fig. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: The Oncologist published by Wiley Periodicals, Inc.


The cases presented underline that a patient without documented candidemia but with a history of neutropenia may well suffer from HSC.

Hepatosplenic Candidiasis Without Prior Documented Candidemia: An Underrecognized Diagnosis?

Computed tomography CT imaging during admission revealed several liver lesions, which, in retrospect, were already present on previous imaging. Core needle biopsy of a liver lesion showed fibrosis, chronic inflammation, and hemorrhage, but no signs of fungi. Case 3 illustrates treatment challenges, with ongoing dissemination and insufficient source control despite months of antifungal therapy, eventually resulting in a splenectomy.

The second case demonstrates the limitations of blood and tissue cultures and the value of molecular methods to confirm the diagnosis. Case 2 responded well to 3 weeks of intravenous echinocandin treatment followed by 2 months of fluconazole. Email alerts New issue alert. Because of these challenges, we believe that many cases of HSC remain unrecognized.