[Hepatosplenic candidiasis in acute leukaemia patients].

BACKGROUND

Hepatosplenic candidiasis is a disseminated invasive fungal infection that may affects patients with acute leukaemia. The main clinical manifestation is a persistent fever in patients recovered from prolonged neutropenia after recent chemotherapy.

METHODS

The authors present three patients, two women and one men, aged 23, 26 and 33 years, with acute leukaemia; one with acute myeloblastic and two with acute lymphoblastic leukaemia who developed hepatosplenic candidiasis. The diagnosis was based on prolonged fever, elevated serum bilirubin and alkaline phosphatase, as well as characteristic lesions on computed tomography, nuclear magnetic resonance and ultrasonographic findings and positive blood culture in one patient. The antifungal treatment was successful in one patient only. Two patients died due to progression of leukaemia.

CONCLUSIONS

If leukaemia patient in remission after chemotherapy develops a prolonged fever of unknown origin, hepatosplenic candidiasis has to be considered and all efforts should be done to diagnose it. The diagnosis is based on clinical presentation and imaging techniques. The positive cultures of fungi are not usually possible and are not mandatory. The antifungal treatment may be prolonged, sometimes 2 to 3 months or even more.