Fungal Balls Mimicking Renal Calculi: A Zebra Among Horses

Das, Manoj Kumar; Pakshi, Rajan Rangrajan; Kalra, Sidharth; Elumalai, Arthi; Theckumparampil, Nithin

doi:10.1089/cren.2019.0012

Cited by 5 publications

(5 citation statements)

References 12 publications

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“… 3 , 5 , 9 Fungal balls could be also directly extracted using flexible ureteroscopy, cystoscopy, PCNL, or by surgical exploration in more complicated cases. 10 - 14 ,21,22 In our case, the treatment of the fungal balls with a systemic antifungal agent (fluconazole) was sufficient enough for a complete eradication of an extensive fungal bezoar infection that was extending through the calyceal systems, ureters, and urinary bladder.…”

Section: Discussionmentioning

confidence: 67%

“…10,21 As in our case, a non-contrasted CT scan could show the fungal balls as low density lesions which might resemble urinary stones and may be reported mistakenly as such. 12 However, as in other reported cases, a CT scan might only show hydronephrosis, fatty stranding around the kidney, and rarely air bubbles without an identifiable lesion of the bezoar, in such cases, a CT scan with an excretory phase can identify the bezoars as filling defects. 9,22,23 Systemic antifungal therapy is the mainstay for treating the bezoars as they originate from a deep parenchymal infection.…”

Section: Discussionmentioning

confidence: 72%

“…Renal pelvis and ureteric bezoars might cause an obstruction with hydronephrosis and elevated kidney function test in which case a nephrostomy or a ureteric stent is usually necessary. [9][10][11][12] The bladder outlet may also get obstructed by the fluffy material of the bezoars and in rare cases, it may lead to bladder perforation if not promptly managed by catheterization. 13,14 As in this case, fungal urinary tract infections may spread through the urinary tract to cause an extensive infection through the urinary tract.…”

Section: Discussionmentioning

confidence: 99%

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Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report

Alrabadi,

Alsabatin,

Masadeh

et al. 2023

Clin Med Insights Case Rep

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Fungal bezoar formation is a complication of fungal urinary tract infections that are usually caused by Candida species and other fungal types. They can form in any site along the urinary tract and may cause an obstruction to the urine flow that would require drainage by nephrostomy, a ureteric stent, and sometimes surgical intervention is needed. In this case report we discuss a case of an adult male who had an extensive fungal bezoar infection caused by Candida tropicalis causing him anuria and acute kidney injury. The bezoars were found in the bladder, the ureters, and both kidneys. The patient was treated with bilateral ureteric stent insertion and with fluconazole for 3 weeks. Bilateral ureteroscopy and urine culture were done after 2 months and they showed that the bezoars have been eradicated on both gross and microscopic levels.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report

Alrabadi,

Alsabatin,

Masadeh

et al. 2023

Clin Med Insights Case Rep

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“…There are even reports about bilateral renal fungal bezoars in infants causing acute kidney failure 6. Das et al reported a case series of two patients who underwent percutaneous lithotomy for bilateral radiolucent staghorn calculi, but pathology revealed the presence of fungal bezoars, and the patients were eventually treated with antifungal agents 7. Furthermore, several authors have reported the presence of vesical fungal balls, often mimicking pathological entities like vesical calculi or even urothelial carcinoma 8–10.…”

Section: Discussionmentioning

confidence: 99%

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

Tsikopoulos,

Papadopoulos,

Anastasiou

et al. 2024

BMJ Case Rep

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Fungal bezoars (fungal balls) are rarely reported in the upper or lower urinary tract. They can be the cause of severe morbidities such as urinary tract obstruction, renal failure and fungaemia. Hereby, we present a rare case of a male patient who underwent transurethral resection of bladder tumour (TURBT), and during his postoperative period, he was diagnosed with bladder fungal bezoars adherent to his resection area. The fungal bezoars were covering an extended area of the right lateral bladder wall, including the right ureteric orifice and causing right urinary tract obstruction. Those findings were manifested only after a relooked cystoscopy and histological evaluation.We aim to present a rare example of fungal bezoars mimicking other pathologies in the urinary tract and review the current literature for similar documentation. We underline the necessity of follow-up examinations for urologists performing TURBT surgeries, including urinalysis, imaging modalities and cystoscopy.

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“…Immunosuppression is associated with increased risk of fungemia, while obstruction or poor urinary flow is more consistent with ascending infection. Treatment of fungal bezoars can be difficult and typically require medical and surgical intervention, including systemic antifungal treatment, antegrade antifungal irrigations through nephrostomy tracts, or even surgical removal via a percutaneous or ureteroscopic approach [6]. Percutaneous access through a PCN tube allows the surgeon to easily debulk or remove proximal fungal infections [7].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

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

et al. 2021

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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.

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Fungal Balls Mimicking Renal Calculi: A Zebra Among Horses

Cited by 5 publications

References 12 publications

Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report

Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report

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

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

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