Mosleh Sultan, Rabaia Dima, Zidan Thabet
Pediatrics Hematology and Oncology, An-Najah National University Hospital, Nablus, PSE.
Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE.
Cureus. 2023 Aug 25;15(8):e44103. doi: 10.7759/cureus.44103. eCollection 2023 Aug.
Chronic disseminated candidiasis (CDC) is a severe form of disseminated fungal infection that commonly affects the liver, spleen, and kidneys. In rare cases, CDC can be further complicated by an excessive immune response known as immune reconstitution inflammatory syndrome (IRIS). This syndrome occurs during the phase of immune recovery and is characterized by a systemic inflammatory response and excessive release of cytokines. We present a case of a two-year-old female with a medical history of acute lymphocytic leukemia on chemotherapy. She was admitted with high fever refractory to conservative management that included broad-spectrum antimicrobials. Additionally, multiple skin lesions and a left-sided limp were noted. Whole-body imaging revealed multiple abscesses in the spleen, kidneys, scalp, and left lower limb. The culture of an aspirate material from skin lesions grew Despite receiving appropriate antifungals, the patient showed no signs of improvement, leading to the diagnosis of CDC-induced IRIS. The patient was started on systemic corticosteroids, which resulted in rapid improvement in the patient's clinical status, resolution of fever, and significant reduction in inflammatory markers.
慢性播散性念珠菌病（CDC）是一种严重的播散性真菌感染，通常累及肝脏、脾脏和肾脏。在罕见情况下，CDC可因一种称为免疫重建炎症综合征（IRIS）的过度免疫反应而进一步复杂化。这种综合征发生在免疫恢复阶段，其特征是全身炎症反应和细胞因子过度释放。我们报告一例两岁女性病例，她有急性淋巴细胞白血病化疗病史。她因高热入院，对包括广谱抗菌药物在内的保守治疗无效。此外，还发现多处皮肤病变和左侧跛行。全身成像显示脾脏、肾脏、头皮和左下肢有多处脓肿。从皮肤病变处抽取的材料培养出……尽管接受了适当的抗真菌药物治疗，但患者没有改善迹象，导致诊断为CDC诱发的IRIS。患者开始使用全身性皮质类固醇治疗，这使患者的临床状况迅速改善，发热消退，炎症标志物显著降低。
