Successful initial treatment with caspofungin alone for hepatosplenic candidiasis in a patient with acute myeloblastic leukemia.

C disseminated candidiasis or Hepatosplenic candidiasis (HSC) is a rare and potentially morbid and mortal complication encountered in febrile neutropenic patients. It is generally associated with recovery from neutropenia, and may occur after the treatment of an episode of acute hematogenous candidiasis. Clinical signs and symptoms include fever unresponsive to antibiotics, abdominal pain and tenderness, and hepatosplenomegaly. Laboratory examination shows negative blood cultures and elevated hepatic enzymes. Multiple abscesses were seen in the liver, spleen, lung, and kidneys. Immediate recognition of this complication and initiation of appropriate treatment is crucial to control the infection and decrease morbidity and mortality.1 A 27-year-old female was admitted to our clinic with the diagnosis of acute myeloblastic leukemia M2 in February 2005. Cytosine arabinoside (ara-C) and Daunorubicin were administered as standard remission induction treatment. 100mg/m2 of Ara-C for 7 days and 45 mg/m2 of Daunorubicin for 3 days were administered. Complete remission was achieved on the 14th day of treatment. In March 2005, a high dose of ara-C was administered for post-remission consolidation therapy. Although blood, sputum, and urinary cultures were negative, imipenem was administered empirically. On thorax CT, ground-glass opacity was detected in the apico-posterior and inferior lingular segment of the left lung and anterobasal segment of the lower lobe of the right lung. Caspofungin was administered in the dose of 70 mg on the first day and 50 mg for subsequent days for the persistency of fever and tomographic findings. In the recovery period of neutropenia, she suffered from right and left upper abdominal pain, nausea, and vomiting. High levels of alkaline phosphatase (ALP) and bilirubin (3.77 mg/dl) persisted. Remission was determined with bone marrow aspiration during this period. She was reevaluated with abdominal ultrasonography and tomography; hepatosplenomegaly, and multiple hypodense lesions with a maximal size of 2 cm in diameter were detected (Figure 1). She was considered as possible hepatosplenic candidiasis according to the