Granulomatous Hepatitis Due to Candida albicans in Patients with Acute Leukemia

Abstract

Deep-seated candidiasis developed after chemotherapy in two patients with acute leukemia. The patients developed granulomatous hepatitis caused by Candida albicans but had no evidence of disseminated candidiasis. Candida could not be isolated from liver biopsies taken from these patients, but yeast and filamentous fungal forms could be identified histochemically within the granulomas found in the biopsy specimens. Quantitation of anticandida antibody levels confirmed that deep-seated candida infection had occurred in both patients. The gastrointestinal tract was the only reasonable portal of entry for Candida in both patients. A diagnosis of candida-induced granulomatous hepatitis should be considered if high, unexplained fever and strikingly elevated serum alkaline phosphatase levels develop in a patient with acute leukemia after an intensive course of chemotherapy.