Adjuvant Corticosteroids for Immune Reconstitution Inflammatory Syndrome in Chronic Disseminated Candidiasis in Pediatric Leukemia

Abstract

Chronic disseminated candidiasis (CDC) is a severe complication in pediatric patients with acute leukemia who are undergoing chemotherapy. During neutrophil recovery, some patients develop immune reconstitution inflammatory syndrome (IRIS), characterized by paradoxical clinical deterioration despite appropriate antifungal therapy. The role of adjuvant corticosteroids in CDC-related IRIS remains undefined. We report the case of two pediatric patients with high-risk B-cell acute lymphoblastic leukemia who developed CDC during consolidation chemotherapy at King Fahad Specialist Hospital Dammam. Despite adequate antifungal therapy, both patients experienced persistent fever, worsening internal organ lesions, and elevated C-reactive protein (CRP) levels during neutrophil recovery, consistent with CDC-related IRIS. Adjuvant corticosteroid therapy was initiated, whereas antifungal treatment was continued. Following the initiation of corticosteroids, both patients demonstrated rapid defervescence (within 24–48 h) and normalization of CRP levels. Both patients successfully completed their planned chemotherapy without recurrence of CDC. This case report highlights the potential role of adjuvant corticosteroid therapy in managing CDC-related IRIS in pediatric patients with acute leukemia, potentially enabling the continuation of life-saving chemotherapy. These cases add to the limited pediatric evidence and support corticosteroid use in carefully selected patients after excluding those with active infection. Further studies are warranted to define optimal patient selection and treatment protocols.