Computerized tomography in the diagnosis of systemic candidiasis in patients with acute leukemia

Seven patients with acute leukemia and systemic candidiasis presented with a clinical syndrome of fever, abdominal pain, organomegaly, and a cholestatic pattern of hepatic dysfunction with an elevated alkaline phosphatase and normal transaminases. The abdominal CT scan demonstrated diffuse hepatic and splenic abscesses in all seven patients. Culture and histology of liver biopsy specimens was nondiagnostic in four of five cases. The CT-directed percutaneous needle aspirations of these lesions yielded diagnostic material in two of three cases. Culture-negative visceral abscesses in persistently febrile patients with acute leukemia should be recognized as being due to candidiasis. The abdominal CT scan may be useful in identifying this clinical-radiographic syndrome and in facilitating rapid diagnosis. Promptly administered antifungal therapy may lead to successful eradication of this infection.