Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient.

In an 18-month period candidal splenic abscesses were diagnosed and treated in eight patients. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, long-term use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with Candida. The patients had a clinical profile of nontoxic appearance with a temperature of more than 38.5 degrees C that was unresponsive to antibiotics, pain and tenderness over the upper abdominal quadrants, focal defects visualized on ultrasound and/or computed tomographic scans, and an elevated alkaline phosphatase level. Candida infection was confirmed by histologic examination of the liver and/or spleen in all patients. Diagnosis was made by percutaneous biopsy in one patient and exploratory laparotomy in seven. Five patients had splenectomy and antifungal drugs. In three patients the fungal abscesses resolved with amphotericin B therapy alone. Seven of eight patients were cured of their splenic abscesses, and five of eight were long-term survivors.