Splenectomy for Treating Hepatosplenic Candidiasis: Two Cases and Literature Review Suggesting its Feasibility

Abstract

Background: Hepatosplenic candidiasis is a rare but severe complication in immunocompromised patients undergoing chemotherapy. Antifungal agents are widely accepted as the first choices for therapy. However, resistance to or side-effect of antifungal agents may compromise its efficiency. Splenectomy has also been rarely performed as treatment for this disease.

Methods: We present two cases of splenectomy for treating hepatosplenic candidiasis after failure of the initial drug therapy. Literatures on splenectomy as treatment for hepatosplenic candidiasis were searched in Pubmed and summarized.

Results: Two leukemia patients developed hepatosplenic candidiasis after received chemotherapy for their primary diseases. Various antifungal agents including amphotericin B were all demonstrated failure to cure fever and the Candida abscesses due to resistance or intractable side-effect. Laproscopic splenectomy were finally performed and resolved the candidiasis successfully. A total of 12 splenectomy cases for treating hepatosplenic candidiasis had been previously reported in literature. All the cases showed either resistance or unimproved to initial antifungal therapies. Splenectomy provided salvage therapeutic value in all cases.

Conclusion: Splenectomy has therapeutic effect and may change the traditional concept in most surgeons. The present study may expand an alternative strategy in clinical practice guideline for the management of hepatosplenic candidiasis.

Funding Information: This work was supported by Natural Science Foundation of Zhejiang Province (LY20H160023, LZ22H030003 and LQ20H1600036) and Research Unit Project of Chinese Academy of Medical Sciences (2019-12M-5-030).

Conflict of Interests: The authors declare that they have no conflict of interest.

Patient Informed Consent Statement: Written informed consent was obtain from the patients for publication of this report.

Keywords: Hepatosplenic candidiasis, Candida, Infectious Disease, Antifungal therapy, Splenectomy