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Adjuvant Corticosteroid Therapy in 2 Children With Hepatosplenic Candidiasis-related IRIS

Saint-Faust, Marie MD*; Boyer, Corinne MD; Gari-Toussaint, Martine MD; Deville, Anne MD*; Poiree, Maryline MD*; Weintraub, Mickael MD, PhD§; Sirvent, Nicolas MD, PhD*

Journal of Pediatric Hematology/Oncology: October 2009 - Volume 31 - Issue 10 - pp 794-796
doi: 10.1097/MPH.0b013e3181b795ec
Clinical and Laboratory Observations

First described in HIV-infected patients who recently initiated highly active antiretroviral therapy, the immune reconstitution inflammatory syndrome (IRIS) is best characterized as a collection of inflammatory disorders triggered by rapid resolution of immunosuppression. Treatment of IRIS is a clinical challenge due to the variety of clinical presentations and the presence of multiple pathogens capable of causing the syndrome. Hepatosplenic candidiasis, an uncommon form of invasive Candida species infection, was recently suggested to belong to the spectrum of fungus-related IRIS. We report 2 cases of probable hepatosplenic candidiasis according to the guidelines of the European Organization for Research and Treatment of Cancer and the Mycosis Study Group, occurring in pediatric patients with acute leukemia during rapid neutrophil recovery after cytotoxic chemotherapy. In both cases, abdominal computed tomography scan revealed multiple hepatic micronodules, and liver biopsy showed nonspecific granulomatous lesions. Hepatosplenic candidiasis symptoms (fever, nausea and vomiting, abdominal pain) resolved within 2 days after adjunction of corticosteroid therapy to antifungal treatment. Inflammatory markers and related radiologic abnormalities decreased or disappeared within 1 month. Recovery of neutrophil count in a context of hepatosplenic candidiasis may result in a heightened inflammatory response. Corticosteroid therapy in this setting is associated with prompt resolution of the symptoms.

Departments of *Pediatric Hematology-Oncology

Pediatric Radiology

Parasitology, Universitary Hospital L'Archet, Nice, France

§Department of Pediatric Hematology-Oncology, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel

Reprints: Marie Saint-Faust, MD, Department of Pediatric Hematology-Oncology, Universitary Hospital L'Archet2, 151 route de Saint-Antoine de Ginestière, 06200 Nice, France (e-mail: mariestfaust@hotmail.fr).

Received for publication August 6, 2008

accepted June 30, 2009

© 2009 Lippincott Williams & Wilkins, Inc.