Kauffman C A, Bradley S F, Ross S C, Weber D R
Department of Internal Medicine, Veterans Administration Medical Center, Ann Arbor, Michigan 48105.
Am J Med. 1991 Aug;91(2):137-41. doi: 10.1016/0002-9343(91)90005-i.
To determine if fluconazole is effective treatment for hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine treatment.
Six patients (ages 3 to 44) with acute leukemia and hepatosplenic candidiasis who did not respond to prior antifungal therapy were treated with fluconazole.
All six patients had fever and three had nausea and vomiting; computed tomographic (CT) scan showed lucencies in the liver in six, lucencies in the spleen in five, and lucencies in the kidneys in three. Prior therapy with 1.6 to 4 g of amphotericin B in the five adults and 526 mg of amphotericin B in the child (with the addition of flucytosine in four) failed to improve clinical symptoms or lucencies in the liver, spleen, and kidneys seen on CT scan. Fluconazole was given at a dose of 200 to 400 mg daily (70 to 100 mg in the child) for 2 to 14 months. All patients had resolution of fever and other symptoms in 2 to 8 weeks. Improvement of the lesions noted on CT scan was seen in 4 to 8 weeks in all patients. Total resolution of lesions noted on CT scan occurred by 4 weeks in two patients, but took 4 to 5 months for three patients and 13 months for one patient. Three patients had relapse of their acute leukemia and two died, presumably cured of their candidiasis. Two patients underwent successful bone marrow transplantation without relapse of their candidiasis.
Fluconazole appears to be useful in the treatment of hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine therapy.
确定氟康唑对两性霉素B和氟胞嘧啶治疗无效的肝脾念珠菌病是否为有效治疗方法。
6例（年龄3至44岁）急性白血病合并肝脾念珠菌病且对先前抗真菌治疗无反应的患者接受了氟康唑治疗。
所有6例患者均有发热，3例有恶心和呕吐；计算机断层扫描（CT）显示6例肝脏有透亮区，5例脾脏有透亮区，3例肾脏有透亮区。5例成人先前接受1.6至4g两性霉素B治疗，儿童接受526mg两性霉素B治疗（4例加用氟胞嘧啶），但未能改善临床症状，也未改善CT扫描所见的肝脏、脾脏和肾脏透亮区情况。氟康唑的给药剂量为每日200至400mg（儿童为70至100mg），持续2至14个月。所有患者在2至8周内发热和其他症状均消失。所有患者在4至8周内CT扫描所见病变有所改善。CT扫描所见病变在4周内完全消失的有2例患者，但3例患者需要4至5个月，1例患者需要13个月。3例患者急性白血病复发，2例死亡，推测念珠菌病已治愈。2例患者成功进行了骨髓移植，念珠菌病未复发。
氟康唑似乎对两性霉素B和氟胞嘧啶治疗无效的肝脾念珠菌病有治疗作用。
