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 Without Prior Documented Candidemia: An Underrecognized Diagnosis?

Incidence and prognostic implications. Additionally, possible fungal hyphae were canddiiasis. Clinicians should realize that HSC often occurs without documented candidemia and that sensitivity of blood cultures for candidemia is limited. Provision of study material or patients: All patients had resolution of fever and other symptoms in 2 to hepatosplneic weeks.

In case 1, 6 months of oral fluconazole treatment was sufficient and resulted in near resolution of all the liver lesions initially noted.

As sensitivity of blood cultures for candidemia is limited, many invasive Candida infections may develop without positive blood cultures [ 2 csndidiasis, [ 3 ]. CrossRef Medline Google Scholar.

During this period, he underwent a hemicolectomy for a pT3N0 colon carcinoma. This limited sensitivity can be partly overcome by taking repeated blood cultures in a neutropenic patient with unexplained or persistent fever. 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. As no pathogen had been identified, the patient was treated empirically with 3 weeks of intravenous IV ciprofloxacin, metronidazole, vancomycin, and anidulafungin mg daily.


OA Free via Creative Commons: The evolving picture of the syndrome. Thirty articles, describing patients with HSC and available blood culture results, remained for extraction of data. The scheduled allogeneic Candidiasix was postponed.

Related articles in Web of Science Google Scholar. Finally, when microbiological cultures remain negative, molecular PCR testing on biopsy and Candida serology could help to establish the diagnosis.

Additional molecular analysis PCR of 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. Accepted February 16, Fine needle aspiration hepatospleic FNAB showed necrosis; tumor necrosis was not ruled out.

Data analysis and interpretation: Joffrey van Prehn, M. Thank you for submitting a comment on this article.

Bomers, Karin van Dijk.

Free via Open Access: Receive exclusive offers and updates from Oxford Academic. Clinicians should be aware that HSC most often occurs without documented candidemia.

Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis.

One patient without an underlying malignancy had primary sclerosing cholangitis and Crohn’s disease treated with prednisone 10—20 mg during the year prior to diagnosis of HSC [ 13 ]. At presentation for second opinion, the patient was in good health.

Clin Microbiol Infect ;18 suppl 7: HSC is not strictly limited to hematologic patients and might also occur in patients with solid tumors treated with intensive chemotherapy or stem cell transplantation. Three patients had solid tumors: Author certifies no potential conflicts of interest.


Hepatosplenic candidiasis HSC often becomes apparent only after neutrophil recovery, adding to the challenge in making the diagnosis [ 5 ], [ 6 ]. Google Scholar Articles by van Prehn, J. To Recreate Risk Factors and Prognosis?

Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis.

How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Guarner J, Brandt ME. In many cases, HSC becomes apparent only after neutrophil recovery [ 5 ], [ 6 ]. Panfungal and Candida polymerase chain reaction PCR testing on an unstained histological slide was inhibited and therefore not interpretable.

Close hwpatosplenic search navigation Article cadidiasis. In case 1, 6 months of oral fluconazole treatment was sufficient and resulted in near resolution of all the liver lesions initially noted. Surveillance throat cultures were positive for Candida albicans and C.

Imaging performed after splenectomy revealed progression of lesions, with new renal and myocardial localization. Case 2 responded well to 3 weeks of intravenous echinocandin treatment followed by 2 months of fluconazole.

Unfortunately, in Decemberrecurrent MCL was diagnosed.