The spectrum of hepatic candidiasis

The liver is affected in up 50 to 75% of compromised hosts with disseminated Candida albicans infection who come to autopsy. The antemortem diagnosis of hepatic candidiasis is rarely made. Blood cultures are negative in approximately 50% of cases, and biochemical parameters of hepatic injury may be of nonspecific value. Additionally, the more commonly seen renal, cardiac, and respiratory involvement may overshadow the hepatic lesion. In a review of 17 autopsy series of disseminated candidiasis, 92 cases with hepatic involvement were identified for a mean prevalence of 13.7%. Hepatic granulomas and microabscesses were the two most common histological lesions attributable to Candida. Inflammatory aggregates, centrilobular congestion, bile stasis, and fatty change were seen less frequently. The diagnosis should be suspected in any compromised host with unexplained fever with or without elevated alkaline phosphatase or bilirubin levels. The diagnosis can be made by percutaneous needle biopsy or at laparoscopy in a majority of cases. Early treatment with Amphotericin is associated with prolonged survival.