<Case Reports>Azole resistant Candida albicans in a leukemic patient : a case report

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A 17-year-old male was diagnosed as having acute myelogenous leukemia. Therapy was not favorable and remission was not obtained. Occult blood was frequently detected and lower abdominal pain, diarrhea and melena appeared during the progression. Since Candida albicans were often isolated from fecal cultures and serological tests by CAND-TEC showed a positive reaction, the patient was diagnosed with intestinal candidiasis. Three series of 400mgs daily Fluconazole administration were performed, but there was no improvement. Using a series of strains isolated from this patient, the in vitro susceptibility and karyotype analysis using pulsed field gel electrophoresis were investigated retrospectively. The isolates were susceptible to azole agents in the early phase of the disease, but shifted to the resistant type during progression. In karyotype analysis, 4 subtypes were observed, and moreover, the types differed between azole-sensitive and azole-resistant strains. These differences indicated the mixed infection by both azole-sensitive and resistant strains.