Fact-sheet: Candidiasis of liver


Updated on 08/26/2020 at 2:21 PM

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Definition

Most common fungal infection, found in 50 to 75% of acute leukemias and 50% of NHL cases at autopsy.

Underlying condition:

  • Acute leukemias
  • NHL
  • Immunosuppression (AIDS, chemotherapy, transplantation)

Micronodular infiltration of fungal abscesses (5-10 mm)

Clinical features

  • Fever
  • Hepatomegaly and splenomegaly
  • Right or left upper quadrant pain
  • Nausea/vomiting
  • Jaundice

Laboratory findings

Work-up for cholestasis

Blood cultures to look for candidemia

Ultrasound

  • Multiple homogeneous hypoechoic nodules
  • "Bull's-eye" pattern: echogenic nidus surrounded by a hypoechoic rim, corresponding to active lesions
  • "Wheel within a wheel" pattern: hypoechoic center, echogenic rim of inflammatory tissue, and hypoechoic rim of fibrosis
  • the nodules are almost always smaller than 10 mm

CT

  • Multiple round abscesses < 10 mm involving both hepatic lobes
  • Small central enhancement producing a target appearance
  • Associated splenic involvement

MRI

Typically hypointense on T1 and hyperintense on T2 with a T2-hypointense rim

Management

Antifungal treatment

Differential diagnosis

Metastasis fo liver

Biliary hamartoma (von Meyenburg complex)