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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In our experience, hepatosplenic candidiasis HSC without documented candidemia often remains unrecognized.
Current guidelines and practices for diagnosis and treatment are described. Improving Detection Detection of HSC may first be improved by acknowledging the limited sensitivity of blood cultures for candidemia.
Total resolution of lesions noted on CT scan occurred by 4 weeks in two patients, but took 4 to 5 months for three patients and 13 months for one patient. A second opinion at hepahosplenic institute hepatosplnic in the diagnosis of hepatic candidiasis without prior documented candidemia, for which she was treated successfully with fluconazole. This is especially important in patients with solid tumors in which candidiasis might be mistaken for metastasis.
To determine if fluconazole is effective treatment for hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine treatment.
The cases presented underline that a patient without documented candidemia but with a history of neutropenia may well suffer from HSC. Potential conflict of interest. In case 1, 6 months of oral fluconazole treatment was sufficient and resulted in near resolution of all the liver lesions initially noted. We describe three cases of HSC without documented candidemia and the challenges in establishing the diagnosis and adequately treating this condition.
Panfungal and Candida polymerase chain reaction PCR testing on an unstained histological slide was inhibited and therefore not interpretable. A case report hpeatosplenic literature survey. Disclosures of potential conflicts of interest may be found at the end of this article.
Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis.
The Infectious Diseases Society of America advises that treatment should be continued until radiologic lesions are calcified or resolved, although others define response to treatment as resolution of clinical and biological signs with stable or reduced lesions on imaging [ 8 ], [ 14 ].
Improvement of the lesions noted on CT scan was seen in 4 to 8 weeks in all patients. Bomersc and Karin van Dijk a.
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. 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.
Hepatosplenic candidiasis: successful treatment with fluconazole.
Antifungal treatment was ceased soon czndidiasis because of rapid clinical recovery and negative microbiological results for Aspergillus infection.
Hepatic candidiasis in cancer patients: Joffrey van Prehn, M. Ophthalmic examination revealed no ocular candidiasis. Unlike most candida infections, attempts to grow the organism or even visualize it on stains have been frequently unsuccessful, and the diagnosis is often based simply on the presence of fever and an abnormal radiographic study.
Hepatosplenic Candidiasis | Clinical Infectious Diseases | Oxford Academic
Because of these challenges, we believe that many cases of HSC remain unrecognized. Three patients had relapse of their acute leukemia and two died, presumably cured of their candidiasis. Outpatient treatment hepatospllenic fluconazole mg once daily administered orally was initiated at 21 months.
Candidisis, when microbiological cultures remain negative, molecular PCR testing on biopsy and Candida serology could help to establish the diagnosis. In conclusion, timely diagnosis of HSC is challenging but can prevent further complications and dissemination and may even prevent unnecessary invasive procedures. Conclusion In conclusion, timely diagnosis of HSC is challenging but can prevent further complications and dissemination and may even prevent unnecessary invasive procedures. The scheduled allogeneic SCT was postponed.
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. Antibiotic treatment consisted of meropenem, vancomycin, and anidulafungin, which was soon ceased after catheter removal. Received Jan 10; Accepted Feb Furthermore, regression of lymphoma masses was seen.
Hepatosplenic Candidiasis Without Prior Documented Candidemia: An Underrecognized Diagnosis?
She subsequently developed pulmonary consolidations 4 months after treatment, for which voriconazole was initiated. 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 ]. A wide range of presenting signs, ranging 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 ].
Antibiotic treatment consisted of meropenem, vancomycin, and anidulafungin, which was soon ceased after catheter removal. The search yielded hits after removal of 1 duplicate see supplemental online Table.