急性白血病の寛解中, 経皮的肝生検により診断し得たCandida albicansによる多発性肝微小膿瘍の1例

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タイトル別名
  • Detection of Liver Microabscess due to Candida Albicans by Liver Biopsy in a Patient with Leukemia during Complete Remission: Report of a Case
  • 急性白血病の寛確中,経皮的肝生検により診断し得たCandida albicansによる多発性肝微小膿瘍の1例
  • キュウセイ ハッケツビョウ ノ カンカクチュウ ケイヒテキ カン セイケン ニ

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A 20-year-old male, a college student, was admitted for progressive anemia and bleeding tendency. Diagnosis of acute myeloblastic leukemia was made from findings in peripheral blood and bone marrow aspiration. Complete remission was achieved by combination of Arabinosyl cytosine and Daunorubicin. During the induction therapy, he was treated successfully with intensive antibiotics therapy and multiple granulocyte transfusion with Hemonetics model 30 for serious bacterial infection. However, he continued to have fever of about 38°C and vague pain in the right upper quadrant of the abdomen with slight elevation of serum transaminase activity. Through evaluation of cause of the fever by blood and urine cultures, chest X-ray, liver scintigram, esophagoscopy, upper G.I. series, barium enema and celiac angiography were negative, fever was refractory to large doses of carbenicillin, sulbenicillin, cephazolin and gentamicin. Percutaneous liver biopsy was performed following platelet transfusion and it revealed the lesion of microabscess due to Candida albicans proved by PAS stain.<BR>Treatment with Amphotericin B was started. The dose was increased to 50 mg daily and maintained. Temperature was decreased and transaminase returned to normal in a week. After four weeks, the second biopsy revealed no lesion. The dose of Amphotericin B was decreased to 25 mg daily. However, two months later, he started having high fever again with redevelopment of abdominal pain and abnormal liver function test. The third biopsy was performed and revealed no lesion. I.V. cholangiogram did not visualize the gall bladder. Culture of bile grew Candida albicans. His general condition gradually deteriorated and expired on March 19th in spite of total dose of 3 gm Amphotericin B therapy. The state of leukemia remained in remission until his death. Autopsy revealed multiple microabscess lesions of the liver.

収録刊行物

  • 感染症学雑誌

    感染症学雑誌 53 (1), 23-28, 1979

    一般社団法人 日本感染症学会

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