CASE REPORT Invasive Candida albicans infection mimicking leukemia in a neonate SERVET OZKIRAZ 1 , AYLIN TARCAN 1 , ZEYNEL GOKMEN 1 , BERKAN GU ¨ RAKAN 1 , BANU BILEZIKCI 2 , & NAMIK OZBEK 3 1 Department of Neonatalogy, Baskent University Faculty of Medicine, Ankara, Turkey, 2 Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey, and 3 Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey (Received 26 February 2007; revised 22 March 2007; accepted 22 March 2007) Abstract Congenital leukemia is rare, and is frequently diagnosed as a form of acute myeloid leukemia at, or immediately after birth. Some infections, viral in particular, can mimic clinical signs and/or laboratory findings of congenital leukemia. This is the first documented case of candidemia resembling leukemia. Keywords: Candida albicans, mimicking, leukemia, neonate, prematurity Case report A 33-year old, gravida 3, para 3 mother delivered an 1100 g male infant at 28 weeks of gestational age by cesarean section. The baby’s Apgar scores at 1 min and 5 min were 5 and 7, respectively. The prenatal and family histories were unremarkable. On initial examination, the infant exhibited respiratory distress with tachypnea, and his chest radiograph was consistent with respiratory distress syndrome. He was intubated and endotracheal surfactant was administered. Laboratory evaluation revealed hemo- globin 14.5 g/dL, hematocrit 45%, white blood cell count 38610 9 /L, platelet count 166610 9 /L, and serum C-reactive protein 69 mg/dL. The differential count on a peripheral blood smear was 80% poly- morphonuclear leukocytes, 11% lymphocytes, and 4% monocytes. Perinatal infection was suspected and the infant was started on a 14-day course of cefotaxime and amikacin. Umbilical arterial and venous catheters were inserted and left in place for 6 days. Then a central transcutaneous silicone line was inserted and left in place for the next 15 days. The patient received parenteral nutrition from day 3 through day 21 of life. Minimal enteral feeding was started after day 5 and full enteral feeding was instituted after day 21. By 3 weeks of life, the baby was gaining weight well, but he developed thrombocytopenia (platelet count 36610 9 /L). Sepsis was suspected, so he was started on imipenem and amikacin. Physical exam- ination, chest and abdominal radiographs, echocar- diography, and cranial ultrasonography at this time revealed nothing remarkable. Blood, throat swab, and urine cultures were all negative, but a culture from the central line catheter grew Candida albicans. This line was removed and parenteral fluconazole was added to the treatment regimen. However, there was no change in the thrombocytopenia; laboratory examination at that stage showed hemoglobin 11 g/ dL, hematocrit 33%, platelet count 30610 9 /L, and white cell count 10610 9 /L, and a peripheral blood smear showed 60% mononuclear cells resembling blasts. Serological tests for cytomegalovirus (CMV), Epstein–Barr virus (EBV), rubella virus, and measles virus were all negative. Serial peripheral blood smears showed persistent atypical mononuclear cells; therefore, bone marrow aspiration and biopsy were performed on postnatal day 40. A smear of the marrow aspirate showed 87% atypical lymphocytes with scant cytoplasm, increased Correspondence: Servet Ozkiraz, MD, Baskent University Medical School, Konya Research and Teaching Hospital, Neonatalogy, Hocacihan Mah. Saray Cad. No: 1, 42080 Selc ¸uklu, Konya, Turkey. E-mail: sozkiraz@yahoo.com The Journal of Maternal-Fetal and Neonatal Medicine, July 2007; 20(7): 555–557 ISSN 1476-7058 print/ISSN 1476-4954 online Ó 2007 Informa UK Ltd. DOI: 10.1080/14767050701412941 J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by HINARI on 12/17/12 For personal use only.