Unexpected presentation of deep candidiasis in a recipient of a mismatched bone marrow transplant

A Caucasian male of 37 years with acute non-lymphoid leukemia underwent a mismatched allogeneic bone marrow transplantation; he was in relapse but otherwise well. After conditioning with cyclophosphamide, total body irradiation and cytosine arabinoside, he received from his sister a graft depleted of T lymphocytes and cyclosporin A. Soon after transplantation he developed fever and a skin rash, followed, after response to high-dose steroids, by fever, acute renal failure, jaundice, progressive loss of consciousness and death after 2 weeks of transplant. Unexpectedly, autopsy revealed deep candidiasis of the liver and kidneys; here the histologic pattern was peculiar, because tubules were filled and occluded by Candida albicans organisms and hyphae. The uniqueness of this case and the fulminating clinical course did not allow to start an appropriate antifungal therapy.