Successful conservative treatment of severe renal candidosis with fungus balls

Rebhandl, Winfried; Saadi, Slim; Herneth, Andreas M.; Presterl, Elisabeth; Paya, Kurosh; Wandl-Vergesslich, K.; Horcher, Ernst

doi:10.1007/s004670050682

Cited by 14 publications

(17 citation statements)

References 23 publications

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“…Candida at such different sites would suggest haematogenous spread and hence the patient was at risk for infection of the heart valves but both transthoracic and transoesophageal echocardiograms were negative [2]. Fortunately he responded well to intravenous Amphotericin B infusions with complete resolution of the fungal balls after 14 days of treatment [3]. Canididal fungal balls can occasionally require insertion of nephrostomy to relieve ureteric obstruction [4], and has been described to cause spontaneous rupture of the adjacent renal vessels in transplant kidneys [5].…”

Section: Discussionmentioning

confidence: 99%

Skeletal and renal manifestations of Candida tropicalis within a diabetic patient (2005:2b)

Birchall

Blackband²,

Ganatra³

et al. 2005

Eur Radiol

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This interpretation corner case in a 22-year-old diabetic with a painful foot and right flank pain highlights the value of investigating incidental urinary tract findings on skeletal scintigram further. The skeletal scintigram revealed increased up in the left 3rd TMT joint and a distended right sided renal collecting system. The subsequent ultrasound revealed multiple fungal balls in this distended system. Urine culture grew C. tropicalis a rarer but recognised cause of fungal ball infection in diabetics this enabled consideration of haematogenous spread of the candidal infection to the foot. Systemic antifungal treatment was commenced with resolution of the fungal balls on ultrasound and resolution of symptoms within the right foot.Keywords Diabetes mellitus . Candida tropicalis . Tc-99 m MDP . Skeletal scintigram . Ultrasound Case reportA 22-year-old man with a 14-year history of insulin dependent diabetes mellitus and a past history of intravenous drug abuse was admitted with painful swelling of the right foot and pain in the right flank. Initial investigations revealed mild renal impairment with a serum creatine of 122 mmol/l, confirmed poor diabetic control with a HbA1C of 10.3% and elevated inflammatory markers with neutrophilia of 8.43×10 9 cells/l, ESR of 97 mm/h and a C reactive protein of 316 mg/l. Plain radiographs of the foot demonstrated osteolysis at the 3rd tarsometarsal joint (TMT) with a well defined sclerotic margin (Fig. 1); subsequently a dual phase skeletal scintigram following administration of Tc-99 MDP was performed (Fig. 2a, b) which demonstrated increased uptake in both phases at the right 3rd TMT joint and a distended right pelvicalyceal system (Fig. 2c). An ultrasound confirmed a distended right pelvicalyceal system and revealed multiple round hyperechoic masses within the renal pelvis (Fig. 3). A subsequent Tc-99 m HMPAO labeled white cell study demonstrated low grade uptake at the right 3rd TMT joint confirming low grade infection at this site. Fig. 1 Oblique radiograph of the left foot

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Section: Discussionmentioning

confidence: 99%

Skeletal and renal manifestations of Candida tropicalis within a diabetic patient (2005:2b)

Birchall

Blackband²,

Ganatra³

et al. 2005

Eur Radiol

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“…Ultrasonographically fungus balls appear as echogenic masses without posterior acoustic shadowing, which is characteristic but not pathognomonic. Published case reports reveal that magnetic resonance imaging, computed tomography scanning, or dimercaptosuccinic acid renal scans are not superior to ultrasonography in detecting renal fungus balls [11,12,13]. They are not practical for serial follow-up either.…”

Section: Discussionmentioning

confidence: 99%

The longest use of liposomal amphotericin B and 5-fluorocytosine in neonatal renal candidiasis

Bıyıklı

Tuğtepe

Akpınar

et al. 2004

Pediatric Nephrology

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Bilateral fungal obstruction of the renal collecting system is rare in infancy. Treatment options include medical or surgical procedures. Reports of successful medical treatment with liposomal amphotericin B have been published but the duration of treatment is controversial. We report a 3-week-old preterm baby with myelomeningocele who had experienced acute renal failure related to bilateral renal fungus balls, which improved with percutaneous nephrostomy and 12 weeks of liposomal amphotericin B intravenously combined with 5-fluorocytosine orally for 9 weeks.

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“…Term babies or older infants born with congenital abnormalities of the renal tract and poor bladder emptying are at higher risk [25,28,46,49,57] by the need for procedures involving the urinary tract, including placement of prosthetic devices (suprapubic catheter, JJ stent) and repeated courses of antibiotic therapy or urinary prophylaxis. These children can develop candiduria and subsequent renal candidiasis [5].…”

Section: Epidemiologymentioning

confidence: 99%

“…C. albicans is thought to be more virulent, causing more organ damage and being more frequently associated with renal obstruction resulting in higher mortality [23,46].…”

Section: Pathogenesismentioning

confidence: 99%

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Clinical practice

Bisht

Voort

2011

Eur J Pediatr

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Renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. Multiple risk factors are usually present. Although rare, some infants develop an obstructive uropathy due to fungal balls, and this requires prompt detection and intervention to preserve kidney function. The management of obstructive renal bezoars is challenging and not well summarised in the past. This is mainly due to scarce literature confined to case reports or case series only. This review clarifies various definitions used in relation to renal candidiasis and identifies infants particularly at risk of obstruction. Clinical presentation, diagnosis and the role of imaging are discussed. A summary of the recent literature is provided to outline the range of existing treatment options available with published drug dosages and mode of delivery used. No single approach is successful in all cases and clinicians need to be aware of the different options available: apart from adequate urinary drainage and use of systemic +/- local antifungal agents, additional treatment with fibrinolytic agents and/or endoscopic or open surgical removal may be required. A new simplified algorithm for use in management is proposed. We hope this review will help clinicians in their management of patients presenting with this complex and challenging diagnosis.

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Successful conservative treatment of severe renal candidosis with fungus balls

Cited by 14 publications

References 23 publications

Skeletal and renal manifestations of Candida tropicalis within a diabetic patient (2005:2b)

Skeletal and renal manifestations of Candida tropicalis within a diabetic patient (2005:2b)

The longest use of liposomal amphotericin B and 5-fluorocytosine in neonatal renal candidiasis

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