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A 6-year-old boy affected by high-risk B cell acute lymphoblastic leukaemia (ALL) was evaluated for persistent, non-localising, abdominal pain after having successfully completed the reinduction phase of high-dose chemotherapy protocol for ALL. On admission, he was in good general condition and afebrile. Physical examination was unremarkable apart from mild abdominal tenderness on palpation at the upper quadrants. Blood tests showed increased C reactive protein (193 mg/L) and ferritin (3286 ng/mL) levels, with normal neutrophil count (2000 /µL) and normal serum transaminases and pancreatic amylase. An infectious disease workup, including blood, urine and stools cultures, blood viral PCR assay, blood galactomannan and beta-D-glucan antigens was negative. A CT of the chest and paranasal sinuses was normal. An abdominal ultrasound showed multiple hypoechoic nodules of 0.5–1 cm diameter, with a feathered border, involving both the liver and the spleen parenchyma (figure 1).
Test your knowledge
What is the most likely diagnosis?
Chronic disseminated candidiasis (CDC)
What would be the next diagnostic step?
Positron emission tomography (PET)
How should this child be managed?
Watch and wait
Long-term antimycotic therapy and adjuvant corticosteroids
Antibiotic therapy with doxycycline
Rifampicin, pyrazinamide, ethambutol and isoniazid
Answers can be found on page 2 .
ANSWERS TO THE QUESTIONS ON PAGE 1
Answer 1. C
CDC, also known …
Contributors LDN drafted the manuscript. EC performed MR and processed images. EB, VK and MR contributed to the conception of the work. SN and EB critically revised the article for relevant intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.