Primary Renal Zygomycotic Infarction Mimicking Renal Neoplasia in an Immunocompetent Patient

Goel, Suman; Carter, James E.; Kahn, Andrea G.; Culpepper, M. I.

doi:10.1097/maj.0b013e3181aa30d0

Cited by 11 publications

(4 citation statements)

References 26 publications

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“…Mucor hyphae may also invade the glomeruli and tubules, sometimes with associated giant cell reaction and granuloma formation [ 27 ]. Clinically, patients with IRM present with fever, flank pain, tenderness, hematuria, pyuria and renal failure, which are usually the result of near total occlusion of the renal arteries or their branches, similar to our patients [ 6 , 28 , 29 ].…”

Section: Discussionsupporting

confidence: 77%

Isolated bilateral renal mucormycosis in apparently immunocompetent patients—a case series from India and review of the literature

Bhadauria

Etta

Chelappan

et al. 2018

Clinical Kidney Journal

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BackgroundIsolated renal mucormycosis (IRM) is a potentially fatal disease affecting immunocompromised hosts. IRM affecting apparently immunocompetent patients is rare, with few previous reports, mostly from India. We describe 10 cases of bilateral IRM with no underlying risk factors.MethodsWe performed a retrospective analysis of cases of IRM from our hospital information system admitted between 2009 and 2016. We analyzed the data of this cohort of IRM, including epidemiological characteristics, clinical presentation, diagnostic procedures, treatment details and outcome.ResultsIn all, 10 cases of bilateral IRM were identified. All of them were males with a mean age of 24.7 years (range 10–42). Most patients were initially managed as acute bacterial pyelonephritis with acute kidney injury. A total of eight patients were diagnosed antemortem. Diagnostic clues include sepsis not controlled with broad-spectrum antibiotics and enlarged kidneys with or without hypodensities on ultrasound/computed tomography imaging. Three patients also gave a specific history of passing white flakes in their urine. Eight patients received specific antifungal therapy with amphotericin B with or without posaconazole. Three patients in whom the disease was apparently confined to the pelvicalyceal system underwent local irrigation with Amp-B. One patient underwent bilateral nephrectomy. Four patients succumbed to the disease while five patients were successfully treated. One patient was discharged against medical advice.ConclusionsIRM is a rare, life-threatening disease associated with high mortality even in immunocompetent individuals. Typical clinical and radiological findings and a high index of suspicion may help in early diagnosis, but definitive diagnosis requires histopathological and/or microbiological confirmation. Early and rapid diagnosis along with aggressive multidisciplinary management including initiation of specific antifungal therapy with or without surgical debridement is vital for a successful outcome.

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Section: Discussionsupporting

confidence: 77%

Isolated bilateral renal mucormycosis in apparently immunocompetent patients—a case series from India and review of the literature

Bhadauria

Etta

Chelappan

et al. 2018

Clinical Kidney Journal

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“…Clinically, most patients with isolated renal mucormycosis presents with fever, flank pain, tenderness, gross hematuria or pyuria (Table 1). 5,7 , 14–20 Blood and urine cultures are often negative and diagnosing mucormycosis almost always requires histopathologic evidence of fungal invasion of the tissues. The biopsy should demonstrate the characteristic wide (3–25 μm in diameters), ribbon‐like, aseptate (pauci‐septate), thin walled hyphae branching at right angles.…”

Section: Discussionmentioning

confidence: 99%

Renal mucormycosis in immunocompetent patients: Report of three cases

Verma¹,

Vij²,

Agrawal³

et al. 2011

Basic and Applied Pathology

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Isolated renal mucormycosis is rare in the immunocompetent host. We retrospectively analyzed all histopathology reports of nephrectomy specimens and renal biopsies from our department in the last year. Three patients of isolated renal mucormycosis were identified. All three patients presented with acute abdomen and renal failure. None had a preceding known predisposing disease for mucormycosis. Ante mortem diagnosis was made in one patient. Fungal culture was positive in one case. We emphasize that isolated renal mucormycosis may affect immunocompetent host and greater clinical suspicion is required for prompt treatment in view of poor prognosis associated with renal mucormycosis.

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“…Renal allograft artery infarction is a characteristic presentation which may prompt suspicion. 23,24,[43][44][45] Vascular invasion of other organs can present with similar complications such as thrombosis or rupture. 25,46 In one instance, graft salvage and stenting of the infarcted allograft was attempted, with eventual case fatality.…”

Section: Discussionmentioning

confidence: 99%

Donor‐derived renal allograft mucormycosis in a combined liver and kidney transplantation: Case report and review of the literature

Thatipelli

Santoiemma

Echenique³

et al. 2020

Transplant Infectious Dis

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Mucormycosis is a spectrum of angio-invasive mold infections from fungi under the order Mucorales, including but not limited to Mucor, Rhizopus, Rhizomucor, Cunninghamella, Absidia, Apophysomyces. 1 The consequences of infection are life-threatening. In addition to maintaining a high index of suspicion, the cornerstones of therapy include prompt diagnosis, reversal of underlying immune dysfunction, early antifungal therapy, and surgical debridement. 2 Mucormycosis may present in any form, but most common syndromes include rhino-orbital-cerebral, pulmonary, or cutaneous involvement, as well as disseminated infection. Isolated renal mucormycosis is rare and appears related to injection-drug use in addition to typical predisposing factors: immunocompromising conditions,

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Primary Renal Zygomycotic Infarction Mimicking Renal Neoplasia in an Immunocompetent Patient

Cited by 11 publications

References 26 publications

Isolated bilateral renal mucormycosis in apparently immunocompetent patients—a case series from India and review of the literature

Isolated bilateral renal mucormycosis in apparently immunocompetent patients—a case series from India and review of the literature

Renal mucormycosis in immunocompetent patients: Report of three cases

Donor‐derived renal allograft mucormycosis in a combined liver and kidney transplantation: Case report and review of the literature

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