Hepatic Candidiasis in a Non-neutropenic Patient

Hepatic candidiasis is an uncommon but serious manifestation of invasive candidiasis (IC), most often associated with prolonged neutropenia in patients with hematological malignancies or in those who have undergone abdominal surgery. Diagnosis is challenging because of the low sensitivity of cultures, the limitations of serologic assays, and the frequent impracticality of tissue biopsy. Imaging, particularly CT and [18F]fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET), plays a central role in identifying characteristic hepatosplenic lesions and in monitoring response to therapy. We present a case of hepatic candidiasis in a non-neutropenic patient presenting with persistent fever and multiple risk factors for IC, highlighting the diagnostic complexity and the importance of maintaining clinical suspicion beyond the classical neutropenic setting. Management requires prompt initiation of appropriate antifungal therapy, thorough evaluation for secondary foci of infection, and prolonged treatment until complete radiologic resolution is achieved to prevent relapse. Current recommendations for the management of deep-seated candidiasis remain largely based on retrospective data and expert opinion. Further research is needed to optimize diagnostic strategies, define the role of molecular diagnostic techniques, and identify patients with underlying genetic susceptibilities that may predispose them to invasive disease.