An autopsy case of disseminated candidiasis producing multiple nodular lesions at the terminal stage of acute leukemia.

概要

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Recently, we have experiented an unusual case of disseminated candidiasis (DC), producing numerous nodular lesions in the multiple organs involving liver and spleen at the terminal stage of acute leukemia. A 26 year-old house wife was diagnosed of acute lymphocytic leukemia and was tried serveral times of combined chemotherapy, but failed to achieve remission. During marked granulocytopenic period, she developed high fever, 39-40°C, and red papules of adzuki-bean size at the trunk and extremities. She has not complained of myalgia, but serum glutamic oxaloacetic transaminase (GOT) was raised to 3185IUIL alone. There were no growth of candida in cultures of blood, throatswab, or urine during life. In autopsy, numerous soy-bean sized nodules were recognized in the liver, and a few such lesions in the spleen, kidneys, stomach, small intestine and left lung. Pathologically, these nodules were composed of coagulation necrosis, and contained innumerable candidal pseudohyphae. In the lung lesion, it was associated with Aspergillus. Such cases were reported only few in Japan, but presumed to increase in the future. It is highly probable that the skin lesions and elevated GOT values in this case were signs of DC. It is recommended to try biopsies actively to establish early diagnosis of DC, when these lesions are noticed in a patient of compromised state.
The Japanese Association for Infectious Diseasesの論文