A case of ureteral fungal mass removal in a patient taking empagliflozin

Abstract

With increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors as antidiabetic agents, the risk of serious fungal urinary tract infection (UTI) may be increased. We present the case of a 67-year-old Caucasian female who was admitted for emphysematous pyelitis and found to have a fungal ball in the renal pelvis. Candida glabrata was cultured and the patient was managed with percutaneous nephrostomy tube placement and antifungal treatment. The fungal ball persisted and required surgical removal with ureteroscopy and basket extraction. Fungal balls can be a difficult sequelae of UTIs requiring a combination of antifungal and surgical intervention for definitive management.

Vesical fungal bezoars on post-TURBT scar tissue causing obstruction and mimicking urothelial carcinoma

“…His type 2 diabetes was not adequately controlled despite being on sodium-glucose cotransporter-2 (SGLT2) inhibitors. The presence of the latter is known to be a major factor in urinary fungal growth, as has been reported again in the literature by Woloshuk et al 12. The combination of the above elements and particularly the use of SGLT2 inhibitors, have likely resulted in fungal growth and fungaemia.…”

Emphysematous Kidney Related to the Use of Empagliflozin in a Diabetic Woman

“… 25 A recent case of a patient with diabetes and a fungal mass associated with empagliflozin has been reported. 26 …”

A Case of Misdiagnosed as Upper Urinary Tract Obstruction Caused by the Fungal Ball

“…15,16 Low postoperative fungemia incidence is achieved by maintaining negative pressure in the renal pelvis and rapidly removing the fungal ball. 17 Following the procedure, fluconazole intravenous infusion, and continuous renal pelvis lavage were employed to effectively prevent and treat the Candida tropicalis fungus. 18,19 Fluconazole 300mg was infused into the renal pelvis for two weeks following the procedure, and fluconazole 400mg was administered orally once daily while in the hospital, and Fluconazole 400mg was continued for four weeks after discharge.…”