Disseminated candidiasis in a previously healthy girl: Implication of a leukocyte candidacidal defect

Abstract

A previously healthy 15-year-old white female presented with a nearly fatal Candida albicans fungemia, peritonitis, and several perforations of the stomach wall with evidence of Candida infiltration. Investigation of this patient's immunologic functions revealed no deficiency of anti- Candida antibody production, in vitro lymphocyte response to mitogens or C. albicans antigen, delayed cutaneous reactivity to Candida antigen, immunoglobulin levels, or serum complement activity. Candidacidal assays using the patient's peripheral blood leukocytes repeatedly gave values significantly below the normal range in both autologous and normal AB serum. This leukocytic defect was still demonstrable more than a year after full recovery from Candida sepsis. Phagocytosis of C. albicans, leukocyte bactericidal activity against gram-positive and gram-negative organisms, nitroblue tetrazolium dye reduction, myeloperoxidase levels, and oxidation of [1- 14C]glucose and [ 14C]formate were normal. This patient apparently has a unique leukocytic defect for which final characterization must await newer methods of investigating leukocyte function.