Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 5-6, Pages: 341-345
https://doi.org/10.2298/SARH1506341C
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Favorable outcome of hepatosplenic candidiasis in a patient with acute leukemia
Čolović Nataša (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Hematology, Belgrade)
Arsić-Arsenijević Valentina (School of Medicine, Belgrade + School of Medicine, Institute of Microbiology and Immunology, National Reference Medical Mycology Laboratory, Belgrade)
Suvajdžić Nada (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Hematology, Belgrade)
Đunić Irena (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Hematology, Belgrade)
Tomin Dragica (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Hematology, Belgrade)
Introduction. 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. Case Outline. 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 2Ч170 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 (IFI) (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. Conclusion.
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.
Keywords: acute leukemia, hepatosplenic candidiasis, laboratory biomarkers, anti-Candida antibody, mannan, computed tomography
Projekat Ministarstva nauke Republike Srbije, br. OI 175034