DIAGNOSIS AND MONITORING RESPONSE TO TREATMENT OF HEPATOSPLENIC CANDIDIASIS IN PATIENTS WITH ACUTE-LEUKEMIA USING MAGNETIC-RESONANCE-IMAGING

Hepatosplenic candidiasis (HSC) is a morbid complication encountered i n immunocompromised individuals, especially, those being treated with intensive chemotherapy protocols for acute leukemia. Immediate recogni tion of this complication and initiation of appropriate treatment is c rucial in order to control the infection, decrease the morbidity and m ortality, and avoid delays in treatment of the underlying condition. T he definitive diagnosis requires either positive blood cultures for ye asts in the presence of abnormal findings on imaging studies consisten t with HSC, or Liver biopsy demonstrating yeast forms or pseudohyphae. We describe our experience in the evaluation of 15 patients with HSC using magnetic resonance imaging (MRI) as a diagnostic and follow-up t ool. The diagnosis of HSC was established by liver biopsy in 11 patien ts (73%), and by positive blood cultures for Candida in 4 patients (27 %). All patients had MRI findings consistent with HSC during the study period. Amphotericin B was administered intravenously to all 15 patie nts (median duration of treatment, 62 days). Repeat MR images were obt ained at 2 weeks, 6 weeks and then at monthly intervals until the reso lution of abnormalities. The median time for the disappearance of MRI lesions was 9 weeks. Alterations in the appearance of lesions on MRI w ere noted throughout chemotherapy in all the 13 (86.6%) responding pat ients. Our results suggest that MRI when used in patients with high cl inical suspicion for HSC provide an alternative for liver biopsy or ot her invasive diagnostic procedures and that appropriate response to tr eatment can be safely monitored by obtaining sequential MRI studies.