A 5-year-old boy with acute lymphocytic leukemia had his third bone marrow relapse. After initial reinduction failed, he was given aggressive reinduction chemotherapy, which led to five weeks of bone marrow hypoplasia. He had repeated high temperatures, but no pathogenic organisms grew from blood cultures. There was no clinical response to antibiotics, although there was bone marrow remission. Physical examination demonstrated hepatomegaly and upper abdominal tenderness. Scintigraphy (using gallium citrate Ga 67) of the abdomen showed normal findings. Abdominal sonography (Fig 1) and computed tomography (CT) (Fig 2) preceded exploratory laparotomy. Urine cultures eventually yielded Candida stellatoidea; additional blood cultures yielded no pathogens.
Denouement and Discussion
Hepatic and Splenic Candidiasis in Acute Leukemia
Abdominal sonography showed splenomegaly with multiple hypoechoic areas. Several hypoechoic areas had central foci of increased echogenicity, suggesting a "bull's-eye" or "target" appearance (Fig 1). Computed tomography demonstrated well-circumscribed, low-density areas within the splenic parenchyma that