Adjuvant Corticosteroid Therapy for Chronic Disseminated Candidiasis
1Université Paris‐7, Service d’Hématologie‐Pédiatrique, Hôpital Robert Debré, 2Université Paris Descartes, Hôpital Necker‐Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker‐Pasteur, and 3Groupe Microorganismes et Barrières de l’Hôte, Équipe Avenir Inserm U604, 4Unité d’Histotechnologie et Pathologie, and 5Centre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moléculaire, CNRS Unité de Recherche Associée 3012, Institut Pasteur, Paris, and 6Université de Franche‐Comté, Service d’Hématologie Clinique, Hôpital Jean Minjoz, and 7Université de Franche‐Comté, Service d’Hémato‐Onco‐Pédiatrie, Hôpital Saint Jacques, Besançon, France
Background.
Chronic disseminated candidiasis (CDC) is typically observed during neutrophil recovery in patients with acute leukemia and requires protracted antifungal therapy.
Objective.Our objective was to document the efficacy and tolerance of corticosteroid therapy (CST) in patients with symptomatic CDC, including those who experienced fever and abdominal pain despite ongoing antifungal therapy.
Methods.We performed a retrospective, multicenter study involving 10 pediatric and adult patients who experienced ongoing symptomatic CDC despite receipt of appropriate antifungal therapy for whom adjuvant oral CST was initiated.
Results.All cases of CDC were proven or probable, as determined on the basis of the European Organization for Research and Treatment of Cancer–Mycosis Study Group definition criteria, and occurred in patients with leukemia. CDC‐attributable clinical symptoms resolved with CST, which was started a mean of 33.8 days after antifungal therapy had been initiated. Fever and abdominal pain disappeared a median of 4–5 days, and serum fibrinogen and C‐reactive protein levels returned to normal values within 14–30 days. The median duration of hospitalization after CST initiation was 8.8 days. Hepatosplenic microabscesses decreased or disappeared within a mean period of 107 days (range, 30–210 days). No relapses of CDC were observed during a median duration of follow‐up of 6.5 years (range, 4–9 years).
Conclusions.In children and adults who experience persistently symptomatic CDC despite ongoing receipt of antifungal therapy, CST involving a prednisone equivalent at a dosage of 
0.5 mg/kg per day for at least 3 weeks is associated with a prompt resolution of symptoms and of inflammatory response. These findings support the pathophysiological hypothesis that CDC belongs to the spectrum of fungus‐related immune reconstitution inflammatory syndrome.
Received 5 July 2007; accepted 31 October 2007; electronically published 28 January 2008.
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