Successfully treated bilateral renal fungal balls with continuous Anidulafulgin irrigation

Abstract

A 73-year-old man with a history of type 2 diabetes mellitus, nephrolithiasis, and recurrent urinary tract infections caused by Candida glabrata was admitted to our hospital. Urosepsis was diagnosed and C. glabrata was isolated from urine and blood cultures. Computed tomography intravenous pyelography (CT-IVP) revealed bilateral filling defects caused by renal fungal balls. Treatment initially comprised intravenous anidulafungin coupled with continuous local anidulafungin irrigation via bilateral nephrostomy tubes, which was followed by high-dose oral fluconazole. This regimen successfully eradicated the C. glabrata in follow-up cultures.

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature

“…Local administration of L-amphotericin B (50–100 mg/L of sterile water), combined with systemic and surgical treatments, is recommended for the management of renal and/or ureteral fungal balls by the Infectious Diseases Society of America [ 52 ]. Alternative antifungal agents described for nephrostomy tube irrigations in adults include fluconazole, anidulafungin, and caspofungin [ 53 , 54 ]. Moreover, deoxycholate amphotericin B at 50 mg/L of sterile water has also been considered in the treatment of lower UTIs, due to fluconazole-resistant Candida spp.…”

Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report

“…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.…”

“…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. 3 Local treatments with antifungals by irrigation with amphotericin B and other antifungals such as fluconazole through nephrostomies or 3 ways urinary catheters have shown to be effective in dissolving the fungal bezoars and are used in most of the reported cases.…”

“…3 Local treatments with antifungals by irrigation with amphotericin B and other antifungals such as fluconazole through nephrostomies or 3 ways urinary catheters have shown to be effective in dissolving the fungal bezoars and are used in most of the reported cases. 3,5,9 Fungal balls could be also directly extracted using flexible ureteroscopy, cystoscopy, PCNL, or by surgical exploration in more complicated cases. [10][11][12][13][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.…”

“… 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 …”