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Hepatosplenic Candidiasis — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsHepatosplenic CandidiasisSCE Infectious Diseases

A 40-year-old man develops febrile neutropenia on day 14 of AML chemotherapy. He is started on Piperacillin/Tazobactam. On day 5 of antibiotics, he remains febrile. CT abdomen shows multiple small hepatic and splenic hypodensities (target lesions). What is the most likely diagnosis?

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Correct answer: B — Hepatosplenic candidiasis (chronic disseminated candidiasis) — target lesions in liver/spleen during neutrophil recovery phase are characteristic

Hepatosplenic candidiasis (chronic disseminated candidiasis — CDC) classically presents as persistent fever with multiple target-like lesions (central necrosis with surrounding inflammation) in the liver and spleen, typically becoming apparent during neutrophil RECOVERY (as the inflammatory response to Candida becomes visible on imaging). Serum beta-D-glucan is usually positive. Blood cultures for Candida are often negative by this stage. Treatment: Liposomal Amphotericin B or echinocandin initially, then prolonged oral Fluconazole (months — until lesion resolution). Chemotherapy can usually continue.

Reference: ECIL-6 2017 – IFD; ESCMID 2024 – Candida; IDSA 2016