A case of disseminated candidiasis with skin manifestations

Candidiasis is the most common fungal infection complicating the course of patients with hematologic malignant neoplasms. Although widespread organ involvement is characteristic of disseminated candidiasis, reports of skin are rare. Reports describing typical clinical and histopathological finding of cutaneous lesions are very important since it may enable a diagnosis of disseminated candidiasis to be made and thus antifungal therapy can be initiated earlier. A 50-year-old housewife was admitted with a 5-month history of fatigue and easy bruising. She was diagnosed as having acute myelocytic leukemia and treatment was begun with daunorubicin and cytosine arabinoside. Eight days after the start of chemotherapy, she developed a fever and generalized tender well demarcated erythematous to purplish papulonodular eruption. A biopsy specimen from the skin lesion showed perivascular mononuclear cell infiltration and spore and pseudohypae were found within the dermis and subcutis in PAS stain. Cultures of one skin biopsy specimen and one of four blood samples grew Candida tropicalis. The patient was treated with intravenous amphotericin B for disseminated candidiasis. On the tenth day of antifungal therapy, she developed cardiopulmonary arrest and died.