title: [The 'bull's eye' pattern in hepatic tomography].
abstract: Invasive fungal infections are more commonly found in patients who develop neutropenia after chemotherapy. A 4-year-old girl with diagnosis of acute lymphoid leukemia developed febrile neutropenia after chemotherapy. Broad spectrum antibiotics and antimycotic therapy were initiated. Candida albicans was isolated and Entamoeba histolytica was observed in stool examination. Chronic disseminated candidiasis had developed and was treated with amphotericin B, initially, and fluconazol. Computed tomography images were obtained that demonstrated a classic 'bull's eye' pattern; a concurrent histological study confirmed the diagnosis. Candida spp. is the major cause of opportunistic mycosis in immunosuppresed patients receiving chemotherapy for haematologic malignancies. An initial infection results in disseminated candidiasis, which persists and becomes chronic. In the 4-year-old patient, the identified risk factors consisted of a previous therapy with broad spectrum antibiotics, the gastrointestinal tract colonization with Candida albicans and prolonged neutropenia. Imaging diagnoses are made by ultrasonography, computed tomography and magnetic resonance. With ultrasound and tomography, 4 distinct patterns have been described. Pattern 1 ('wheels within wheels') and 2 ('bull's eye') are important, since they are characteristic of chronic disseminated candidiasis. The third pattern (hypoechoic image) is the most common finding with both techniques. In the current patient, patterns 2 and 3 were seen and the diagnosis was confirmed by histological study.
authors.affiliation: Grupo de Infectología, Instituto Nacional de Cancerología, E.S.E., Bogotá, DC, Colombia. infectologia@incancerologia.gov.co
authors.forename: Jorge Alberto
authors.initials: JA
authors.lastname: Cortés
authors.forename: Sonia Isabel
authors.initials: SI
authors.lastname: Cuervo
authors.forename: Luis Francisco
authors.initials: LF
authors.lastname: Hernández
authors.forename: Guillermo
authors.initials: G
authors.lastname: Potdevin
authors.forename: Ana María
authors.initials: AM
authors.lastname: Urdaneta
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004748:Entamoeba histolytica / Q000302:isolation & purification; D005243:Feces / Q000469:parasitology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008100:Liver Abscess / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole