Hepatosplenic candidiasis

Last revised by Craig Hacking on 18 Aug 2021

Hepatosplenic candidiasis is a manifestation of disseminated candidiasis in immunosuppressed patients, particularly those receiving chemotherapy for hematological malignancies. Both hepatic and splenic infection usually happens simultaneously, the reason why they are approached together.  

On imaging, it typically presents as multiple microabscesses scattered through the liver and splenic parenchyma. 

Candida species are the most common fungi to infect the liver and the spleen 1

Usually, the presentation occurs in at-risk immunosuppressed patients, with fevers unresponsive to usual antibiotics.  

Candida species can invade the intestinal mucosa during periods of marked neutropenia and invade the liver through the portal circulation 2

  • wheel within a wheel sign: central hypoechoic area corresponding to necrosis/fungal debris; an inner hyperechoic ring of inflammatory cells; and a peripheral hypoechoic area representing fibrosis
  • bull's-eye sign: similar to above but lacking the central hypoechoic necrosis/fungal debris
  • hypoechoic nodule (most common pattern of presentation): representing fibrosis on an area of prior inflammation
  • echogenic focus of scar or calcification
  • small circumscribed hypoattenuating lesions 
  • occasionally, tiny central foci of increased attenuation may be seen within, likely reflecting pseudohyphae 

The mortality rate is about 30% despite antifungal therapy 1

  • other than the liver and spleen, the kidneys are the most commonly affected organ in systemic candidiasis 2, therefore, active search for concomitant renal microabscess should be performed 

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Cases and figures

  • Case 1
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  • Case 2
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