title: Usefulness of corticosteroid therapy during chronic disseminated candidiasis: case reports and literature review.
abstract: OBJECTIVE
  Chronic disseminated candidiasis (CDC) is a disseminated fungal infection that is frequently seen in patients undergoing intensive treatment of haematological malignancies. The first signs of CDC appear during neutrophil recovery. Clinical and physiopathological characteristics of CDC suggest it belongs to the spectrum of fungus-related immune reconstitution inflammatory syndrome (IRIS). We report five cases of CDC treated with antifungal therapy and adjuvant corticosteroids to decrease the exacerbated inflammatory response.
  
  
  METHODS
  We conducted a retrospective study in the Haematology Department of the University Hospital of Tours, France. The five reported cases were treated for CDC with antifungal therapy and adjuvant corticosteroids.
  
  
  RESULTS
  Of the five cases of CDC, one was proven and four were possible, according to the 2008 European Organization for Research and Treatment of Cancer (EORTC) classification. All patients were being treated for acute leukaemia. In all cases, symptoms disappeared 2.8 days (range, 1-7) after the beginning of adjunctive corticosteroid therapy. Corticosteroids were administered on average for 146 days (range, 4 weeks-1 year) and antifungal therapy was administered for the duration of chemotherapy consolidation. There was no exacerbation of CDC symptoms during the next round of chemotherapy or bone marrow transplantation. One patient died from relapse of leukaemia.
  
  
  CONCLUSIONS
  Within the framework of IRIS, adjuvant corticosteroid therapy could rapidly improve CDC symptoms and allow continued chemotherapy without delay and without compromising the haematological prognosis.
authors.affiliation: CHRU de Tours,  Service de Médecine Interne et Maladies Infectieuses, Tours,  France.
authors.forename: H
authors.initials: H
authors.lastname: Chaussade
authors.forename: F
authors.initials: F
authors.lastname: Bastides
authors.forename: S
authors.initials: S
authors.lastname: Lissandre
authors.forename: P
authors.initials: P
authors.lastname: Blouin
authors.forename: E
authors.initials: E
authors.lastname: Bailly
authors.forename: J
authors.initials: J
authors.lastname: Chandenier
authors.forename: E
authors.initials: E
authors.lastname: Gyan
authors.forename: L
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D002177:Candidiasis / Q000188:drug therapy* / Q000473:pathology; D002908:Chronic Disease; D004359:Drug Therapy, Combination / Q000379:methods; D005602:France; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents