Hepatic Candidiasis Following Drug-Induced Neutropenia in ANCA-Associated Vasculitis: A Diagnostic Challenge

An 82-year-old woman with antineutrophil cytoplasmic antibodies-associated vasculitis and previous azathioprine-induced neutropenia presented with 5 days of right upper quadrant pain, nausea, and vomiting. Laboratory evaluation revealed leukocytosis (34.14/nL) and cholestasis (alkaline phosphatase 2,296 U/L, total bilirubin 4.3 mg/dL). Computed tomography demonstrated a 16.4 × 12.0 cm multiloculated perihepatic fluid collection. Blood cultures were negative. Hepatic candidiasis was diagnosed by culture of drained fluid, which grew Candida albicans . Treatment with fluconazole and percutaneous drainage with adjunctive fibrinolytics achieved complete resolution at 9 weeks. This case underscores the importance of considering hepatic candidiasis in immunocompromised patients with persistent or atypical liver lesions, even in the absence of candidemia or typical imaging findings.