title: [Favorable Outcome of Hepatosplenic Candidiasis in a Patient with Acute Leukemia].
abstract: BACKGROUND
  Acute leukemias treatment requires strong chemotherapy. Patients that develop bone marrow aplasia become immunocompromised, thus becoming liable to bacterial and fungal infections. Fungal infections caused by Candida are frequent. Hepatosplenic candidiasis (HSC) is a frequent consequence of invasive candidiasis which is clinically presented with prolonged febrility unresponsive to antibiotics.
  
  
  METHODS
  A 53-year-old patient with acute myeloid leukemia was submitted to standard chemotherapy "3+7" regimen (daunoblastine 80 mg i.v. on days 1 to 3, cytarabine 2 x 170 mg i.v. during 7 days) and achieved complete remission. However, during remission he developed febrility unresponsive to antibiotics. Computerised tomography (CT) of the abdomen showed multiple hypodense lesions within the liver and spleen. Haemocultures on fungi were negative. However, seroconversion of biomarkers for invasive fungal infection (FI) (Candida and Aspergillus antigen/Ag and antibody/Ab) indicated possible HSC. Only high positivity of anti-Candida IgG antibodies, positivity of mannan and CT finding we regarded sufficient for the diagnosis and antimycotic therapy.Three months of treatment with different antimycotics were necessary for complete disappearance of both clinical symptoms and CT findings.
  
  
  CONCLUSIONS
  In patients with prolonged febrile neutropenia IFI has to be strongly suspected. If imaging techniques show multiple hypodense lesions within liver and spleen, HSC has to be taken seriously into consideration. We believe that, along with CT finding, positive laboratory Candida biomarkers (mannan and IgG antibodies) should be considered sufficient for"probable HSC" and commencement of antifungal therapy, which must be long enough, i.e. until complete disappearance of clinical symptoms and CT findings are achieved.
authors.forename: Nataša
authors.initials: N
authors.lastname: Čolović
authors.forename: Valentina Arsić
authors.initials: VA
authors.lastname: Arsenijević
authors.forename: Nada
authors.initials: N
authors.lastname: Suvajdžić
authors.forename: Irena
authors.initials: I
authors.lastname: Djunić
authors.forename: Dragica
authors.initials: D
authors.lastname: Tomin
mesh_terms: D000208:Acute Disease; D000935:Antifungal Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002177:Candidiasis / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D011859:Radiography; D012074:Remission Induction; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents