Hepatosplenic candidiasis - A manifestation of chronic disseminated candidiasis

Hepatosplenic candidiasis, also chronic disseminated candidiasis, is differentiated from acute disseminated candidiasis based on clinical presentation, risk factors, and natural history. The disease occurs almost exclusively in patients with leukemia and is characterized by fever after recovery from prolonged neutropenia, abdominal complaints, and abnormalities in liver function. Although Candida albicans is the most common pathogen, non-albican Candida species and opportunistic fungi have been identified as causative agents. Imaging techniques are valuable for diagnosis and management; although diagnosis is difficult. Liver biopsy and culture may be the only method to establish diagnosis; however, the organism may not be cultured from liver tissue in 50% of patients. Antifungal therapy is complicated by the intercurrent immunosuppression related to chemotherapy and should be prolonged and tailored to the patient's individual response. Newer azoles and the lipid formulations of amphotericin B are promising therapies and appear to be more efficacious than amphotericin B desoxycholate. The disease has been virtually eliminated in institutions where fluconazole has been used prophylactically in susceptible patients. Increased understanding of the pathophysiology of this infection is needed to improve methods for diagnosis and management.