Computed tomography of hepatic and splenic fungal abscesses in leukemic children

Six hundred fifty-eight abdominal computed tomography scans of 275 children with cancer were retrospectively studied for evidence of multiple hepatic or splenic "abscess-like" lesions. Seven patients, all with subsequently confirmed fungal disease, were found to have such lesions. In addition to acute leukemia, all patients had prolonged fever not responsive to antibiotics, had neutropenia (less than 500 neutrophils per mm3) and had received anticancer chemotherapy for up to 4 weeks before the positive computed tomography scans. We conclude that the presence of multiple well-circumscribed hepatic or splenic lesions on the abdominal computed tomography scan of a febrile, neutropenic, immunosuppressed patient not responding to antibiotics and with no other source of infection is strong evidence for systemic fungal infection. However, the absence of such lesions may not exclude the diagnosis of systemic mycosis.