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Percutaneous Management of Systemic Fungal Infection Presenting As Bilateral Renal Fungal Ball

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ABSTRACT

Background:: Zygomycoses are uncommon, frequently fatal diseases caused by fungi of the class Zygomycetes. The majority of human cases are caused by Mucorales (genus—rhizopus, mucor, and absidia) fungi. Renal involvement is uncommon and urine microscopy, pottasium hydroxide mount, and fungal cultures are frequently negative.

Case presentation:: A twenty-one-year-old young unmarried lady presented to our emergency department with bilateral flank pain, fever, nausea, and decreased urine output of one-month duration. She was found to have azotemia with sepsis with bilateral hydronephrosis with a left renal pelvic obstructing stone. Even after nephrostomy drainage and broad spectrum antibiotics, her condition worsened. She developed disseminated fungal infection, and timely systemic antifungal followed by bilateral nephroscopic clearance saved the patient.

Conclusion:: Although renal fungal infections are uncommon, a high index of suspicion and early antifungal and surgical intervention can give favorable outcomes.

No MeSH data available.


(a) Noncontrast computed tomography (NCCT) scan of the abdomen at presentation. (b) NCCT scan of the abdomen after amphotericin B therapy. (c) NCCT scan of the abdomen after nephroscopic clearance.
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f1: (a) Noncontrast computed tomography (NCCT) scan of the abdomen at presentation. (b) NCCT scan of the abdomen after amphotericin B therapy. (c) NCCT scan of the abdomen after nephroscopic clearance.

Mentions: In November 2015, a 21-year-old young lady presented to our emergency department with bilateral flank pain, fever, nausea, and decreased urine output for the past 1 month. There was no relevant history. She was febrile (102°F) and tachypneic, with pulse of 110/minute and blood pressure 90/60 mm Hg. Bilateral flank tenderness was noted. Blood investigations revealed anemia (Hb 7.5 g/dL), total leucocytic count of 19,000/dL, blood urea 234 mg/dL, and serum creatinine 19 mg/dL with metabolic acidosis on blood gas analysis. After initial resuscitation, she underwent ultrasound scan of whole abdomen followed by noncontrast computed tomography (NCCT) scan of abdomen that revealed bilateral gross hydronephrosis with left emphysematous pyelonephritis with left renal pelvic stone and right infected hydronephrosis with hyperdense material in the pelvicaliceal system (Fig. 1a).


Percutaneous Management of Systemic Fungal Infection Presenting As Bilateral Renal Fungal Ball
(a) Noncontrast computed tomography (NCCT) scan of the abdomen at presentation. (b) NCCT scan of the abdomen after amphotericin B therapy. (c) NCCT scan of the abdomen after nephroscopic clearance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC5035836&req=5

f1: (a) Noncontrast computed tomography (NCCT) scan of the abdomen at presentation. (b) NCCT scan of the abdomen after amphotericin B therapy. (c) NCCT scan of the abdomen after nephroscopic clearance.
Mentions: In November 2015, a 21-year-old young lady presented to our emergency department with bilateral flank pain, fever, nausea, and decreased urine output for the past 1 month. There was no relevant history. She was febrile (102°F) and tachypneic, with pulse of 110/minute and blood pressure 90/60 mm Hg. Bilateral flank tenderness was noted. Blood investigations revealed anemia (Hb 7.5 g/dL), total leucocytic count of 19,000/dL, blood urea 234 mg/dL, and serum creatinine 19 mg/dL with metabolic acidosis on blood gas analysis. After initial resuscitation, she underwent ultrasound scan of whole abdomen followed by noncontrast computed tomography (NCCT) scan of abdomen that revealed bilateral gross hydronephrosis with left emphysematous pyelonephritis with left renal pelvic stone and right infected hydronephrosis with hyperdense material in the pelvicaliceal system (Fig. 1a).

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Zygomycoses are uncommon, frequently fatal diseases caused by fungi of the class Zygomycetes. The majority of human cases are caused by Mucorales (genus—rhizopus, mucor, and absidia) fungi. Renal involvement is uncommon and urine microscopy, pottasium hydroxide mount, and fungal cultures are frequently negative.

Case presentation:: A twenty-one-year-old young unmarried lady presented to our emergency department with bilateral flank pain, fever, nausea, and decreased urine output of one-month duration. She was found to have azotemia with sepsis with bilateral hydronephrosis with a left renal pelvic obstructing stone. Even after nephrostomy drainage and broad spectrum antibiotics, her condition worsened. She developed disseminated fungal infection, and timely systemic antifungal followed by bilateral nephroscopic clearance saved the patient.

Conclusion:: Although renal fungal infections are uncommon, a high index of suspicion and early antifungal and surgical intervention can give favorable outcomes.

No MeSH data available.