Adjuvant corticosteroid therapy in hepatosplenic candidiasis-related IRIS

Abstract

Candida infections are the most frequent infections in neutropenic patients. Hepatosplenic candidiasis (HSC) is a part of disseminated Candida infection that occurs most commonly in patients with hematologic malignancies treated with chemotherapy and requires protracted antifungal therapy. During invasive mycosis with rapid resolution of immunosuppression, immune reconstitution inflammatory syndrome (IRIS) which mimics treatment failure, drug toxicity or breakthrough infections may occur. Manifestation period, histopathologic findings and favorable effect of steroids to its inflammatory symptoms strongly suggest that HSC belongs to the invasive fungal infection induced IRIS. We present a child with B cell-acute lymphoblastic leukemia who developed HSC and addition of corticosteroid therapy to antifungal treatment achieved rapid resolution of the clinical symptoms and laboratory findings.

Chronic Disseminated Candidiasis in Children and the Role of Corticosteroids Therapy

“…2 CDC-related IRIS should be considered in children with persistent fever, exaggerated inflammatory response and persistent symptoms on antifungal therapy once other causes were excluded. 4,10 Response to corticosteroids with CDC induced IRIS is similar to other types of IRIS that are commonly seen with human immunodeficiency virus (HIV) patients. 4 Corticosteroids can modulate the phagocytic function and T-cell activation, which may result in resolution of fever and biochemical abnormality.…”

A case of chronic disseminated candidiasis in metamizole-induced neutropaenia

“…Due to adverse effects (mostly immunosuppressive effects), the use of corticosteroids in IFD-IRIS is still controversial. However, addition of corticosteroids to antifungal therapy in CDC-associated IRIS was shown to be safe and to lead to rapid clinical improvement, especially cessation of fever, in all reported cases [5,[9][10][11][12][13][14][15]. It also allowed for the planned treatment for the underlying haematological disease to continue.…”

Candida-Related Immune Response Inflammatory Syndrome Treated with Adjuvant Corticosteroids and Review of the Pediatric Literature

“…The most commonly administered antifungal agent was amphotericin B. Details of steroid therapy and the outcomes are presented in Table 1 [ 3 , 7 , 8 , 9 , 10 , 11 ]. Increased susceptibility to infection might be a drawback for prolonged corticotherapy.…”