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Hepatic candidiasis in a patient with acute myeloid leukaemia

A 46-year-old man was hospitalized with fever, malaise and abdominal pain following a period of pancytopenia secondary to induction chemotherapy for acute myeloid leukaemia. Physical examination revealed only hepatomegaly. The full blood count showed Hb 11 g/dl, platelet count of 84 10/l and white blood cell count of 23 ́8 10/l. Fibrinogen was 7 ́30 g/l, alkaline phosphatase 1222 U/l, aspartate aminotransferase 101 U/l, alanine aminotransferase 510 U/l and g-glutamyltranspeptidase 560 U/l. He was started on empiric ceftazidime and amikacin. Because of multiple positive blood cultures for Candida albicans and persistent fever, he was also started within a few days on amphotericin B (1 mg/kg body weight/d). An ultrasound examination and a computerized tomography abdominal scan (top) showed multiple hepatic abscesses that were biopsied without result. The patient underwent an exploratory laparotomy that showed multiple white turbinate spicules on the surface of Glisson's capsule (bottom). These were biopsied and fungal elements compatible with candida were seen in the histological sections. Antifungal therapy was continued for 6 months and his condition improved slowly. He is currently well and free of malignant disease and fungal infection.