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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All patients had resolution of fever and other symptoms in 2 to 8 weeks.

Hepatosplenic candidiasis: successful treatment with fluconazole.

Fluconazole was given at a dose of to mg daily 70 to mg in the child for 2 to 14 months. The guidelines should include recognition of the pathophysiology of this condition and provide recommendations regarding antifungal therapy and the use of antiinflammatory agents. Google Scholar Articles by van Prehn, J. Although concomitant antifungal therapy may be necessary, it is unlikely that symptoms would persist such that months of therapy would be required if steroids are added to the regimen.

Hepatosplenic Candidiasis Without Prior Documented Candidemia: An Underrecognized Diagnosis?

Hepatosplenic candidiasis in the era of new antifungal drugs: New insights into hepatosplenic candidosis, a manifestation of chronic hepatosllenic candidosis.

Multiple fungal spores intermingled with hyphae and pseudohyphae can be seen, consistent with Candida spp. At 11 months, she was admitted for a short period of time with an influenza B infection. Notes The copyright line for this article was changed on 26 June after original online publication. Furthermore, regression of lymphoma masses was seen.

Improving Detection Detection of HSC may first be improved by acknowledging the limited sensitivity of blood cultures for candidemia. All six patients had fever and three had nausea and vomiting; computed tomographic CT scan showed lucencies in the liver in six, lucencies in the spleen in five, and lucencies in the kidneys in three.


A wide range of presenting signs, hepatosplenkc from imaging abnormalities only case 1 to abnormal liver tests cases 2 to persistent fever of unknown origin case 3challenge the diagnosis of chronic disseminated candidiasis [ 8 ]. Detection of HSC may first be improved by acknowledging the limited sensitivity hepatosplenc blood cultures for candidemia. Literature Review of HSC and Candidemia 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.

Initial growth and, after treatment, regression of liver lesions was seen. Treatment 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. Routine blood cell count, inflammation parameters, and renal and liver tests were normal, with only a mild thrombocytopenia. Initial growth and, after treatment, regression of liver lesions was seen.

Hepatosplenic Candidiasis | Clinical Infectious Diseases | Oxford Academic

If a patient with a history of neutropenia has liver lesions and imaging or biopsy is not typical for metastasis, one should try to confirm the diagnosis of HSC.

Author information Article notes Copyright and License information Disclaimer. Blood cultures were positive with E. CrossRef Medline Google Scholar.

Hepatosplenic candidiasis: successful treatment with fluconazole.

Panfungal and Candida polymerase chain reaction PCR testing on an unstained histological slide hepatosplenci inhibited and therefore not interpretable. Adults with haematological malignancies and after haematopoietic stem cell transplantation HCT.


The European Society for Clinical Microbiology and Infectious Diseases recommends the following investigations as essential for the diagnosis of chronic disseminated candidiasis: N Engl J Med ; The diagnosis of hepatic candidiasis was supported by positive Candida antibody mannan serology Soon after initiation of antibiotic therapy, he developed purple skin lesions, suggestive of candidemia, for which voriconazole was added to the antibiotic treatment.

In our experience, hepatosplenic candidiasis HSC without documented candidemia often hepagosplenic unrecognized. Moreover, a hhepatosplenic hemihepatectomy was prevented. HSC is not strictly limited to hematologic patients and might also occur in patients with solid tumors treated candiidiasis intensive chemotherapy or stem cell transplantation. Citing articles via Web of Science 1.

You must accept bepatosplenic terms and conditions. Joffrey van Prehn, Email: The diagnosis of hepatic candidiasis was supported by positive Candida antibody mannan serology Clinicians might not be aware that HSC often occurs without prior documented candidemia. The first patient had a history of SCT for treatment of breast cancer and was scheduled for hemihepatectomy for suspected liver metastasis.

Histopathologic diagnosis of fungal infections in the 21st century. New insights into hepatosplenic candidosis, a manifestation of chronic disseminated candidosis.

Antibiotic treatment consisted of meropenem, vancomycin, and anidulafungin, which was soon ceased after catheter removal. Joffrey van Prehn, C. Hepatosplenomegaly and multiple focal hepatic lesions can be seen.

Antifungal treatment was ceased soon thereafter because of rapid clinical recovery and cqndidiasis microbiological results for Aspergillus infection. Disclosures of potential conflicts of interest may be found at the end of this article.