Candida Tropicalis renal microabscesses in a child with leukemia confirmed using nucleic acid amplification and recovery after prolonged antifungal and corticosteroid treatment

Abstract

We report the first case of microabscesses detected by polymerase chain reaction (PCR) amplification of nucleic acid from ultrasound-guided aspirated fluid in a three-year old boy with acute lymphoblastic leukemia and febrile neutropenia during induction chemotherapy. Fever persisted despite effective antifungal treatment. The addition of corticosteroid therapy successfully controlled the suspected immune reconstitution inflammatory syndrome (IRIS). This case highlights the utility of PCR and adjunctive corticosteroid in the approach of Candida tropicalis renal microabscesses in leukemic patients undergoing chemotherapy.

Subcutaneous Microabscesses and Myositis as Part of Immune Reconstitution Inflammatory Syndrome due to Chronic Disseminated Candidiasis in a Child With Acute Lymphoblastic Leukemia

“…In the first phase, there is a gut translocation of candida species into the bloodstream because of probable underlying mucosal sloughing during the prolonged neutropenic phase or gastrointestinal bleeding leading to the seeding of candida in various organs 3,8. Liver, spleen, lungs, and kidneys are the usual organs of involvement, but in our case, an unusual presentation of subcutaneous microabscesses was seen, though the culture from the abscesses did not yield any fungal growth 9–12. As per European Organization for Research and Treatment of Cancer guidelines, our case was proven invasive fungal infection with a positive blood culture 13.…”

“…Although prednisolone is the most common type of steroid used, there are no trials or recommendations on its dosage and duration. Like in our patient, the majority of the reported cases have commenced prednisolone at 1 to 2 mg/kg and tapered over time, with the total duration ranging anywhere between 6 days and 8 months based on the clinical discretion of treating physicians 8–12. Our patient’s CRP reduced within a week but has had a persistent high neutrophil count.…”

“…3,8 Liver, spleen, lungs, and kidneys are the usual organs of involvement, but in our case, an unusual presentation of subcutaneous microabscesses was seen, though the culture from the abscesses did not yield any fungal growth. [9][10][11][12] As per European Organization for Research and Treatment of Cancer guidelines, our case was proven invasive fungal infection with a positive blood culture. 13 The second phase, which begins with the recovery of leukocyte counts, leads to the paradoxical worsening of an underlying apparent or latent seeding of these candida foci.…”

Candida tropicalis Systemic Infection Redirects Leukocyte Infiltration to the Kidneys Attenuating Encephalomyelitis

“…Although the fungal load was diminished in the spleen and the CNS after two weeks of infection, it remained elevated in the kidneys, suggesting a tropism of the C. tropicalis for this organ. The kidney involvement by C. tropicalis was already described in a murine experimental model [ 42 ] and in humans [ 15 , 43 ], which was relevant in most systemic Candida infections since this may lead to death by renal failure [ 44 ].…”

“…In this regard, C. tropicalis was isolated from systemic infections all over the world, being the second most prevalent yeast in Brazil and the third in South America [9][10][11][12]. Moreover, C. tropicalis was reported in CNS infections [13,14] and associated to renal microabscesses [15,16].…”