Hepatosplenic candidiasis in patients with acute leukaemia

A retrospective study of 23 patients with acute leukaemia and hepatosplenic candidiasis (HSC) was conducted to evaluate clinical treatment characteris tics in terms of amount and duration of antifungal agents and to assess tre atment outcome. Patients were admitted to two major tertiary care centres between 1990 and 1998. The diagnosis of HSC was based on clinical, blood cultures, histologi c and imaging studies. Patients were treated with amphotericin B without in terruption of the planned chemotherapy regimens. Serial magnetic resonance imaging (MRI) studies were the main tool for following patients' response a nd activity of the fungal lesions in conjunction with clinical and laborato ry parameters. Treatment with amphotericin B was continued until resolution of all clinica l symptoms and signs attributable to HSC, obtaining negative blood cultures and the appearance of at least healed lesions on MRI. Amphotericin B was d iscontinued in four patients because of severe nephrotoxicity (two patients ), or continuous fever and persistent fungal lesions on MRI (two patients). Amphotericin B lipid complex (ABELCET) was successfully used as salvage th erapy for these refractory patients. Four patients died with evidence of HS C despite treatment and supportive measures. The response rate for treatmen t of HSC was 82%. The mean total dose of amphotericin B including empirical treatment was 4 g and the median duration of treatment for responding pati ents was 112 d. The median number of days of antifungal treatment before th e disappearance of fever was 19 d. Our results confirmed the need for protracted courses of antifungal agents for the successful eradication of HSC. Chemotherapy for the underlying diso rder should not be interrupted or delayed in order to treat HSC.