CandidaBezoars with Urinary Tract Obstruction in Two Women without Immunocompromising Conditions

Abstract

More than half of the cases of fungal infections of the urinary tract are caused by Candida sp., but occurrence of obstructive uropathy caused by mycetomas or fungus balls (urobezoars) is extremely rare. The latter are conglomerates of fungal hyphae. Diabetes mellitus, immunosuppression, chronic disease, and malignancies are known predisposing factors. Preoperative imaging is not pathognomonic; blood clots, radiolucent urinary calculi, air bubbles, and inflammatory debris can mimic urobezoars. We report on two otherwise healthy women presenting with urinary tract obstruction caused by candidal mycetomas of the renal pelvis that mimicked matrix lithiasis.

Management of a Renal Fungal Bezoar Caused by Multidrug-Resistant Candida Glabrata

“…Th e most common causes of fungal bezoars are C. albicans and C. tropicalis (3)(4)(5)(6)(7). C. glabrata may have inherent resistance to azoles, which are typically fi rst-line agents for treatment of candidal urinary tract infections.…”

Candida dubliniensisencrustation of an obstructing upper renal tract calculus

“…Fungal bezoars are usually seen in the immunocompromised patient or in the patient with diabetes or a chronic alcoholic, particularly with prolonged urethral catheterisation and prolonged courses of antibiotics 1. There are some reports of Candida bezoars in patients without immunocompromising conditions 2. Fungal bezoars are rarely encountered in clinical practice.…”

Rapidly progressive kidney failure induced by fungal mycelia obstructing indwelling ureteral stents

“…Urinary infection or colonisation by fungi is important to recognise prior to ureteral stenting, since cases of Candida urosepsis have been reported following the procedure 6–8 . C albicans is the most frequent microorganism3 9 but infections by Candida tropicalis 10 11 or Torulopsis glabrata have also been reported 12…”

“…A systemic chemotherapy, usually fluconazole or echinocandine, is thus required, especially in a situation of disseminated infection 19. If fungus balls have arisen, a percutaneous extraction is another option 3 12…”