INTRODUCTION Hepatosplenic candidiasis is a disseminated invasive fungal infection that may affects patients with acute leukemia. The main clinical manifestation is a persistent fever in patients recovered from prolonged neutropenia after recent chemotherapy. CASE OUTLINE The authors present three patients, two women and one men, aged 23, 26 and 33 years, with acute leukemia; one with acute myeloblastic and two with acute lymphoblastic leukemia who developed hepatosplenic candidiasis. The diagnosis was based on prolonged fever, elevated serum bilirubin and alkaline phosphatase, as well as characteristic lesions on computed tomography, nuclear magnetic resonance and ultrasonographic findings and positive blood culture in one patient. The antifungal treatment was successful in one patient only. Two patients died due to progression of leukemia. CONCLUSION If leukemia patient in remission after chemotherapy develops a prolonged fever of unknown origin, hepatosplenic candidiasis has to be considered and all efforts should be done to diagnose it. The diagnosis is based on clinical presentation and imaging techniques. The positive cultures of fungi are not usually possible and are not mandatory. The antifungal treatment may be prolonged, sometimes 2 to 3 months or even more.
434 Castleman disease presented with prolonged fever of unknown origin