Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review

Abstract

Patient: Male, 60Final Diagnosis: Renal fungal ballSymptoms: FeverMedication: —Clinical Procedure: Fluconazole instillation through nephrostomy tubeSpecialty: UrologyObjective:Unusual setting of medical careBackground:Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection. In debilitated or immunosuppressed septic patients, who have upper urinary tract obstruction with renal filling defect, fungal infection should be considered.We report on a patient with sepsis and renal fungal ball who was treated with percutaneous nephrostomy and intravenous antifungal agent, but the patient did not respond so instillation of fluconazole through nephrostomy was given.Case Report:A 60-year-old male patient with a known case of diabetes mellitus with refractory urine retention underwent transurethral resection of the prostate. Postoperatively, the patient developed recurrent high-grade fever with left loin pain, and elevated septic parameters; urine and blood culture were positive for Candida albicans. Computed tomography urography showed left hydronephrosis with filling defect in the left renal pelvis with suspected renal fungal ball. Left percutaneous nephrostomy was performed and intravenous fluconazole started but the fever did not subside, therefore, the treatment was changed to anidulafungin. The patient improved but urine from both the bladder and the nephrostomy remained positive for candida. Instillation of fluconazole at 300 mg in 500 mL normal saline was applied through the nephrostomy tube over 12 hours at 40 mL/hour for 7 days.Conclusions:Renal fungal ball is rare but can be serious, especially in immunocompromised patients. Management options for renal fungal ball include intravenous antifungal agents and percutaneous nephrostomy with antifungal instillation of antifungal agents. The objective of this case report was to document treatment success with the use of fluconazole instillation through a nephrostomy tube.

Successfully treated bilateral renal fungal balls with continuous Anidulafulgin irrigation

“…We did not find any case reports of successful irrigation with an echinocandin, this is probably due to the known efficacy and cost-effectiveness of amphotericin B. 4 , 5 …”

Successful Endoscopic Management of a Renal Fungal Ball using Flexible Ureterorenoscopy

“…e use of such equipment can be helpful in management of patient in fungal ball as it can both expedite treatment and reduce length of hospital stay for such patients. is is in direct contrast with the variable and o en prolonged treatment that is required with the use of current established treatment with nephrostomy and direct antifungal instillation which averages around seven days [1].…”

“…Most of the reported cases of fungal ball in literature were managed by either long term antifungal therapy or local antifungal instillation through a nephrostomy tube [1,12,13,15,16]. Current management options for renal fungal ball include intravenous antifungal agents, percutaneous nephrostomy with instillation of antifungal agents with no consensus over the duration of instillation required.…”

“…is case report aims to demonstrate an alternative method for management of candiduria due to fungal ball in the kidney. Most reported cases in literature were managed by intravenous antifungal treatment and antifungal instillation through percutaneous nephrostomy tube [1].…”

A Rare Case of Urinary Tract Fungal Ball Leading to Fungemia and Bilateral Chorioretinitis

“…Reports of a urinary tract fungal ball leading to separate findings of fungemia, emphysematous pyelonephritis and cystitis, and bilateral fungal chorioretinitis are rare in the literature [ 5 – 8 ]. This patient's urine cultures were negative for bacteria and positive for only C. tropicalis , which has been shown to be a gas producer in the literature [ 9 ].…”