Focal hepatic candidiasis: a distinct clinical variant of candidiasis in immunocompromised patients.

Focal hepatic candidiasis is a distinct clinical variant of candidiasis in immunocompromised hosts. Although affected patients may exhibit previous evidence of extra-hepatic candidal infection, manifestations of disease at the time hepatic involvement is documented are localized to the liver. Five cases of focal hepatic candidiasis in immunocompromised patients were diagnosed antemortem in the past 15 months at our institution. Clinical, laboratory, and radiologic findings from those five patients, as well as from 20 additional cases reported in the medical literature, are reviewed. Patients with focal hepatic candidiasis had fever unresponsive to antimicrobial therapy, prominent gastrointestinal symptoms and signs, elevated levels of alkaline phosphatase, and hepatic, with or without accompanying splenic, defects noted on abdominal computed tomography. Liver biopsy usually revealed yeast and/or hyphal forms, but cultures were frequently negative. Response to therapy occurred in only 13 (59%) of 22 assessable patients. The apparent increasing incidence of focal hepatic candidiasis may be due to the recent use of more intensely cytotoxic chemotherapies for cancer.