Focal hepatic candidiasis with perihepatic adhesions: laparoscopic and immunohistologic diagnosis

Two patients developed fever, cholestasis, and neutropenia following chemotherapy for acute leukemia. Computed tomographic scans of the liver were nondiagnostic, but peritoneoscopy in each case showed diffuse studding of the liver surface with white plaques. Microbiological cultures of the biopsy specimens were negative, but direct immunofluorescence stains of deparaffinized sections of the biopsies confirmed candidiasis. Follow-up laparoscopy in 1 patient after 2 mo of treatment with amphotericin B showed development of diffuse perihepatic adhesions. Peritoneoscopy is valuable in the diagnosis and management of focal hepatic candidiasis, and an etiologic diagnosis can be provided by immunohistology when microbiological culture of the biopsy specimen is negative or unavailable.