Hepatosplenic candidiasis complicating acute myeloid leukaemia.

A 33-year-old man with acute myeloid leukaemia developed neutropenic fever after induction chemotherapy with cytarabine and daunorubicin. The first blood culture was positive for Escherichia coli and the patient was treated with imipenem (500 mg every 6 hours intravenously [IV]). However, the fever persisted and liver function tests were deranged; alkaline phosphatase (ALP) was 166 U/L (reference range, 50-120 U/L), alanine aminotransferase (ALT) was 61 U/L (reference range, 10-40 U/L), and bilirubin was 220 μmol/L (reference range, 5-21 μmol/L). Repeat blood culture was negative. Computed tomography (CT) showed multiple new hypo-enhancing nodules scattered over the liver, spleen, and kidneys (Fig 1). A diagnosis of hepatosplenic candidiasis was made, and the patient responded to treatment with amphotericin B (40 mg daily IV). After recovery of the neutrophil count, the patient started oral fluconazole (400 mg daily) and his ALP and bilirubin returned to normal.