Adjuvant corticosteroid therapy for chronic disseminated candidiasis.
BACKGROUND
Chronic disseminated candidiasis (CDC) is typically observed during neutrophil recovery in patients with acute leukemia and requires protracted antifungal therapy.


OBJECTIVE
Our objective was to document the efficacy and tolerance of corticosteroid therapy (CST) in patients with symptomatic CDC, including those who experienced fever and abdominal pain despite ongoing antifungal therapy.


METHODS
We performed a retrospective, multicenter study involving 10 pediatric and adult patients who experienced ongoing symptomatic CDC despite receipt of appropriate antifungal therapy for whom adjuvant oral CST was initiated.


RESULTS
All cases of CDC were proven or probable, as determined on the basis of the European Organization for Research and Treatment of Cancer-Mycosis Study Group definition criteria, and occurred in patients with leukemia. CDC-attributable clinical symptoms resolved with CST, which was started a mean of 33.8 days after antifungal therapy had been initiated. Fever and abdominal pain disappeared a median of 4-5 days, and serum fibrinogen and C-reactive protein levels returned to normal values within 14-30 days. The median duration of hospitalization after CST initiation was 8.8 days. Hepatosplenic microabscesses decreased or disappeared within a mean period of 107 days (range, 30-210 days). No relapses of CDC were observed during a median duration of follow-up of 6.5 years (range, 4-9 years).


CONCLUSIONS
In children and adults who experience persistently symptomatic CDC despite ongoing receipt of antifungal therapy, CST involving a prednisone equivalent at a dosage of > or =0.5 mg/kg per day for at least 3 weeks is associated with a prompt resolution of symptoms and of inflammatory response. These findings support the pathophysiological hypothesis that CDC belongs to the spectrum of fungus-related immune reconstitution inflammatory syndrome.
Legrand
Faézeh
F
Université Paris-7, Service d'Hématologie-Pédiatrique, Hôpital Robert Debré, Paris, France.
Lecuit
Marc
M
Dupont
Bertrand
B
Bellaton
Erianna
E
Huerre
Michel
M
Rohrlich
Pierre-Simon
PS
Lortholary
Olivier
O
D015746:Abdominal Pain / Q000382:microbiology; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002177:Candidiasis / Q000188:drug therapy* / Q000503:physiopathology; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000382:microbiology; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D007902:Length of Stay; D007938:Leukemia / Q000150:complications; D008100:Liver Abscess / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D005340:Fibrinogen; D002097:C-Reactive Protein