Fungal ball in urinary tract, a rare entity, which needs a specific approach

Praz, V.; Burruni, Rodolfo; Meid, Florian; Wisard, M.; Jichlinski, Patrice; Tawadros, Thomas

doi:10.5489/cuaj.1254

Cited by 25 publications

(17 citation statements)

References 11 publications

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“…Fungal balls that originate from inflammatory debris, sloughed renal papilla, mucous debris, and lithiasic debris can cause urinary tract obstruction. This makes urinary tract candida infection persistent and difficult to eradicate [ 2 ]. Radiologic features of fungus balls, although characteristic, are not pathognomonic and can be mimicked by blood clots, radiolucent urinary calculi, air bubbles, inflammatory debris, and transitional cell carcinoma; the typical aspect is an intraluminal filling defect of the drainage system sometimes leading to obstruction [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection [ 1 ]. The fungi extend into the collecting system and rarely coalesce to form bezoars or fungus balls, which can cause hydronephrosis and obstructive uropathy [ 2 ]. In debilitated or immunosuppressed septic patients with upper urinary tract obstruction with renal filling defect, fungal infection should be considered, and a urine specimen culture is advisable.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review

et al. 2018

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Patient: Male, 60Final Diagnosis: Renal fungal ballSymptoms: FeverMedication: —Clinical Procedure: Fluconazole instillation through nephrostomy tubeSpecialty: UrologyObjective:Unusual setting of medical careBackground:Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection. In debilitated or immunosuppressed septic patients, who have upper urinary tract obstruction with renal filling defect, fungal infection should be considered.We report on a patient with sepsis and renal fungal ball who was treated with percutaneous nephrostomy and intravenous antifungal agent, but the patient did not respond so instillation of fluconazole through nephrostomy was given.Case Report:A 60-year-old male patient with a known case of diabetes mellitus with refractory urine retention underwent transurethral resection of the prostate. Postoperatively, the patient developed recurrent high-grade fever with left loin pain, and elevated septic parameters; urine and blood culture were positive for Candida albicans. Computed tomography urography showed left hydronephrosis with filling defect in the left renal pelvis with suspected renal fungal ball. Left percutaneous nephrostomy was performed and intravenous fluconazole started but the fever did not subside, therefore, the treatment was changed to anidulafungin. The patient improved but urine from both the bladder and the nephrostomy remained positive for candida. Instillation of fluconazole at 300 mg in 500 mL normal saline was applied through the nephrostomy tube over 12 hours at 40 mL/hour for 7 days.Conclusions:Renal fungal ball is rare but can be serious, especially in immunocompromised patients. Management options for renal fungal ball include intravenous antifungal agents and percutaneous nephrostomy with antifungal instillation of antifungal agents. The objective of this case report was to document treatment success with the use of fluconazole instillation through a nephrostomy tube.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review

et al. 2018

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“…A conclusive diagnosis of fungal bezoar requires clinical, laboratory, and imaging studies. Clinically, abdominal pain and hematuria along with signs and symptoms of pyelonephritis and acute kidney injury constitute the most commonly encountered presentations [ 9 ]. Growing a microbiological culture of the pathogen from the urine and determining predisposing factors facilitate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…The most described therapeutic approach is urinary drainage by a nephrostomy and/or a ureteral catheter with systemic and local antifungal administration [ 11 ]. Nephrostomy also provides access to percutaneously remove the fungus ball and manually drain it via ureteroscopy [ 9 ]. In our patient, endoscopic removal of the fungus ball was successful, coupled with fluconazole treatment initiated prior to the procedure and given only systemically for 2 weeks' duration.…”

Section: Discussionmentioning

confidence: 99%

Fungal Bezoar: A Rare Cause of Ureteral Obstruction

Zeineddine

Mansour

Bitar

et al. 2017

Case Reports in Infectious Diseases

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A 52-year-old male, with diabetes mellitus and alcoholic liver disease, presented to the Emergency Room for right flank pain of 3 days' duration, associated with dysuria. Physical examination revealed right flank tenderness with fever and hypotension; laboratory findings showed acute kidney injury and large blood and leucocytes in the urine. A CT abdomen and pelvis showed hydronephrosis of the right collecting system of a horseshoe kidney with air and hyperdense debris in the renal pelvis. Patient was treated for multisensitive Proteus mirabilis emphysematous pyelonephritis, and a right nephrostomy tube was inserted. Symptoms recurred in 4 weeks, and repeated urine culture grew Candida albicans and CT scan showed same high density material within the right moiety of the horseshoe kidney. Patient underwent ureteroscopy, and a white fluffy material was aspirated from the right renal pelvis. Pathology of the aspirate confirmed the presence of fungal balls. Patient was given 2 weeks of oral fluconazole. Fungal pyelonephritis is unusual and difficult to treat. Candida species is responsible for the clear majority of the cases. A fungus ball should be managed with surgical and medical therapy. This patient had an endoscopic procedure to remove the fungus ball and received fluconazole. His symptoms resolved and urine culture was done before termination of the treatment was negative.

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“…Development of renal fungal balls in an adult patient is extremely rare; however, risk factors for development include diabetes mellitus, prolonged antibiotic therapy, and malnutrition. [ 5 ] Our patient had all the three of these risk factors: Poor glycemic control with extremely brittle diabetes, an extended antibiotic course for osteomyelitis, and significant malnutrition. Primary therapy for fungus balls, especially with Candida , includes systemic therapy with amphotericin B +/− flucytosine or fluconazole, but almost always requires an invasive procedure to remove the bulk of the infection.…”

Section: Discussionmentioning

confidence: 99%

Acute hepatic injury with amphotericin B deoxycholate in an immunocompetent patient

Wagner

Bell

2016

Journal of Pharmacology and Pharmacotherapeutics

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Amphotericin B deoxycholate (AmBd) is rarely used due to its adverse effect profile, which includes nephrotoxicity, infusion-related reactions, and hepatotoxicity. The incidence of hepatotoxicity related to AmBd is 18–23%, but the reports of this adverse effect are mainly in immunocompromised patients receiving chemotherapy. We report a case of AmBd-related acute hepatic injury in an immunocompetent male with multiple medical problems. The patient initially had acute hepatic injury likely caused by poor nutritional status and a diagnosis of failure to thrive, but was recovering. He was also diagnosed with bilateral renal fungal mycetomas and received systemic treatment initially with micafungin and then fluconazole after urine cultures returned with the growth of Candida glabrata. Therapy was expanded to systemic AmBd when the fungal balls persisted. The patient subsequently developed hepatic re-injury with 1 dose of AmBd, and the therapy was discontinued. Caution should be exerted when utilizing AmBd in treating patients with previous hepatic injury.

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Fungal ball in urinary tract, a rare entity, which needs a specific approach

Cited by 25 publications

References 11 publications

Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review

Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review

Fungal Bezoar: A Rare Cause of Ureteral Obstruction

Acute hepatic injury with amphotericin B deoxycholate in an immunocompetent patient

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