title: Fluconazole in the treatment of hepatosplenic candidiasis.
abstract: Hepatosplenic candidiasis has increased in frequency among immunocompromised hosts. Risk factors include hematologic malignancy, intensive chemotherapy, prolonged neutropenia, and treatment with broad-spectrum antibiotics. Patients most commonly present with abdominal pain, persistent fevers despite antibiotic therapy, and an elevated alkaline phosphatase level that is out of proportion to other hepatic enzyme levels. Gastrointestinal mucosal damage secondary to intensive chemotherapy may allow colonization with Candida species and subsequent seeding of the portal vein. Treatment has consisted of prolonged courses of amphotericin B, with mortality rates approaching 50%. We report a case of hepatosplenic candidiasis in a patient with acute myelogenous leukemia who had clinical and radiographic improvement during fluconazole therapy. Fluconazole may be an efficacious and less toxic alternative to amphotericin B.
authors.affiliation: Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33606.
authors.forename: M T
authors.initials: MT
authors.lastname: Flannery
authors.forename: D B
authors.initials: DB
authors.lastname: Simmons
authors.forename: H
authors.initials: H
authors.lastname: Saba
authors.forename: P
authors.initials: P
authors.lastname: Altus
authors.forename: P M
authors.initials: PM
authors.lastname: Wallach
authors.forename: H M
authors.initials: HM
authors.lastname: Adelman
mesh_terms: D002177:Candidiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000276:immunology; D008107:Liver Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013158:Splenic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D015725:Fluconazole