HEPATOSPLENIC YEAST INFECTION IN PATIENTS WITH ACUTE-LEUKEMIA - A DIAGNOSTIC PROBLEM

The occurrence of hepatosplenic candidiasis following prolonged neutro penic periods has emerged as a major problem for patients with leukemi a. In order to evaluate the diagnostic value of various available proc edures, we analyzed our findings regarding 26 leukemic patients with h epatosplenic candidiasis. A significantly increased level (>50 mg/L) o f serum C-reactive protein (S-CRP) was significantly more common than a daily fever (for which the mean temperature peak was >37.5 degrees C ) or raised levels of liver enzymes (serum alanine transferase, aspart ate transferase, or alkaline phosphatase). Focal changes in the liver, spleen, or kidneys were detected in >90% of the patients examined by computed tomography (CT) but in <50% of those examined by ultrasonogra phy. Seventeen diagnoses were based on the findings from microscopy of samples obtained invasively, whereas a positive fungal culture was th e basis of the diagnosis for only five patients. In conclusion, monito ring the S-CRP level after a patient's recovery from neutropenia is us eful in that its elevation is cause for early suspicion of hepatosplen ic candidiasis. In detection of the hepatosplenic foci, CT is superior to ultrasonography. For establishing the specific diagnosis, aggressi ve collection of samples for microscopy is essential.