Behçet's Disease with Bilateral Renal Infarction Due to Mucormycosis

Shimoyama, Kumiko; Niwa, Tomoyuki; Furukawa, Shogo; Morishita, Naomi; Nagakura, Yuka; Yonezawa, Haruka; Hatakeyama, Masakazu; Okubo, Yusuke; Suzuki, Daisuki; Kosugi, Isao; Shiogama, Kazuya; Ogawa, Noriyoshi

doi:10.2169/internalmedicine.7462-21

Cited by 3 publications

(3 citation statements)

References 23 publications

(31 reference statements)

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“… 5 The precise underlying mechanism of RM is not well understood; however, ascending movement of RM from the lower urinary tract to the kidney and spreading throughout the bloodstream are possible mechanisms. 9 The hallmark clinical features of RM encompass fever, flank pain (either unilateral or bilateral), hematuria, anuria, oliguria, and pyuria. 5 , 8 Due to nonspecific clinical features, most of the patients with RM can be misdiagnosed as acute pyelonephritis and be treated by antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…RM is more prevalent in Asia, especially India, with preponderance in males with a mean age of 33 5 . The precise underlying mechanism of RM is not well understood; however, ascending movement of RM from the lower urinary tract to the kidney and spreading throughout the bloodstream are possible mechanisms 9 . The hallmark clinical features of RM encompass fever, flank pain (either unilateral or bilateral), hematuria, anuria, oliguria, and pyuria 5,8 .…”

Section: Discussionmentioning

confidence: 99%

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Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report

Darouei,

Zare,

Torkashvan

et al. 2024

Clinical Case Reports

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Key Clinical MessageUnilateral renal mucormycosis is a rare infection that should be suspected in patients with recurrent renal infections presenting nonspecific clinical features that do not respond to conventional therapies, especially in impaired immune systems due to related risk factors. Moreover, histopathological examinations should be performed to confirm the diagnosis. For treatment, the preference is that the patient is hospitalized, and surgical intervention and rapid administration of intravenous antifungals for 2–3 weeks are the treatment choices. After discharge, the patient should be followed up with periodic blood urea nitrogen and creatinine levels and, if needed, an imaging modality such as a CT scan or sonography.AbstractRenal mucormycosis (RM) is a rare form of mucormycosis infection and is more often in immunocompromised patients with risk factors. Unilateral renal involvement is infrequent in patients and is available as case reports. This condition usually presents with renal colic, fever and chills, and oliguria and has a high mortality rate. Herein, we report a case of unilateral renal mucormycosis presenting with pyelonephritis and acute kidney injury in a 32‐year‐old patient. The patient had numerous urological procedures in previous years due to nephrolithiasis state, which put him in an immunocompromised state. The histopathological examination of the pylocalyceal system revealed a collection of broad non‐septated fungal hyphae branching at 90° accompanied by numerous neutrophils and necrotic tissue in favor of mucormycosis. He was successfully treated with 5 mg/kg/day Liposomal Amphotericin B for 3 weeks, discharged with good general condition, and remained asymptomatic for 3 months after discharge. The diagnosis of RM relies on solid clinical suspicion, which can be authenticated by histopathological examination, and the combination of antifungal therapy and surgical intervention can result in a good outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report

Darouei,

Zare,

Torkashvan

et al. 2024

Clinical Case Reports

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show abstract

“…Kidney involvement, renal mucormycosis (RM), has been reported in up to 20–22% of the cases with disseminated forms ( 5 , 6 ). The exact mechanism of RM is not clear yet; however, retrograde spread from lower urinary tract infection and blood dissemination to the kidneys have been suggested ( 7 ). Thus, in high-risk patients, early demonstration of the infection in the urine and cystoscopy assessment of the bladder could be helpful to avert dissemination as bladder can also be a portal of entry for Mucorales ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

et al. 2022

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BackgroundRenal mucormycosis (RM) is a rare presentation of invasive mucormycosis with a high mortality rate. There is no single systematic review of the literature that indicates the different clinical aspects of RM.MethodsA systematic search of PubMed/Medline was performed to collect individual case reports of RM in patients of all ages published between 2010 and April 2022.ResultsSeventy-one individual cases were detected through PubMed bibliographic database searches, with a final assessment performed on 60 patients with RM. India and Asia had the largest number of reported cases, with 30 (50%) and 42 (70%) reports, respectively. Also, 74 and 26% of the patients with a mean age of 33 years were male and female, respectively. RM showed 44% mortality rate in the analyzed cases. Immunosuppressive agent therapy followed by tissue transplantation (kidney and liver) and diabetes were the most remarkable risk factors in patients. Nevertheless, 22% of the patients were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in eight adult patients with an 87% mortality rate. The most common signs of infection were fever, flank pain, and oliguria; additionally, isolated RM was reported in 57% of the cases. In 55% of the patients, histopathologic examination alone was sufficient to diagnose RM, whereas molecular methods and culture were used in only 18 and 35% of patients, respectively. Surgery alone, surgery plus anti-infection therapy, and anti-infection therapy alone were used in 12, 60, and 13% of patients, respectively. Furthermore, 15% of the patients died before any treatment.ConclusionThe early diagnosis of RM is necessary. In this regard, the use of molecular-based diagnostic assays can help identify the fungus at the genus and species levels and use an appropriate treatment in the shortest possible amount of time. Because of the increase in antibiotic resistance in recent years, determining microbial susceptibility tests can lead to the better infection management. Additionally, withdrawal of immunosuppressant, appropriate surgical intervention, and antifungal therapy are the main factors associated with a successful outcome in RM.

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Part 1: Mucormycosis: prevalence, risk factors, clinical features, and diagnosis

Lynch

Fishbein

Abtin

et al. 2023

Expert Review of Anti-infective Therapy

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Behçet's Disease with Bilateral Renal Infarction Due to Mucormycosis

Cited by 3 publications

References 23 publications

Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report

Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report

Clinical presentations, diagnosis, management, and outcomes of renal mucormycosis: An overview of case reports

Part 1: Mucormycosis: prevalence, risk factors, clinical features, and diagnosis

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