1
|
Alrabadi A, Alsabatin N, Masadeh HM, Hadidy A, Al-shudifat A. Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231220998. [PMID: 38148952 PMCID: PMC10750544 DOI: 10.1177/11795476231220998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 11/30/2023] [Indexed: 12/28/2023]
Abstract
Fungal bezoar formation is a complication of fungal urinary tract infections that are usually caused by Candida species and other fungal types. They can form in any site along the urinary tract and may cause an obstruction to the urine flow that would require drainage by nephrostomy, a ureteric stent, and sometimes surgical intervention is needed. In this case report we discuss a case of an adult male who had an extensive fungal bezoar infection caused by Candida tropicalis causing him anuria and acute kidney injury. The bezoars were found in the bladder, the ureters, and both kidneys. The patient was treated with bilateral ureteric stent insertion and with fluconazole for 3 weeks. Bilateral ureteroscopy and urine culture were done after 2 months and they showed that the bezoars have been eradicated on both gross and microscopic levels.
Collapse
Affiliation(s)
- Adel Alrabadi
- Division of Urology, Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Nedal Alsabatin
- Division of Urology, Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | | | - Azmi Hadidy
- Department of Radiology, School of Medicine, University of Jordan, Amman, Jordan
| | - Abdulrahman Al-shudifat
- Division of Neurosurgery, Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| |
Collapse
|
2
|
Huber L, Engelhardt PF, Riedl C. Intravesical Mycetoma misdiagnosed as enterovesical fistula. Urol Case Rep 2023; 50:102517. [PMID: 37601833 PMCID: PMC10432988 DOI: 10.1016/j.eucr.2023.102517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
Fungus formation in the urinary tract mainly occurs in immunosuppressed patients, and is a rare and dangerous complication of candiduria that is commonly misdiagnosed. We report a case of intravesical mycetoma associated with hydronephrosis, initially diagnosed as enterovesical fistula. Cystoscopy revealed spongy material within the urinary bladder, and histopathological examination showed Mycetoma of Candida species. The urine culture showed Candida tropicalis. Endoscopic removal and antifungal therapy with fluconazole was initiated, and no complications occurred during follow-up.
Collapse
Affiliation(s)
- Livia Huber
- Department of Urology and Andrology, Landesklinikum ThermenregionBaden, Austria
| | - Paul F. Engelhardt
- Department of Urology and Andrology, Landesklinikum ThermenregionBaden, Austria
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Claus Riedl
- Department of Urology and Andrology, Landesklinikum ThermenregionBaden, Austria
| |
Collapse
|
3
|
A Rare Case of Urinary Tract Fungal Ball Leading to Fungemia and Bilateral Chorioretinitis. Case Rep Urol 2020; 2020:8828289. [PMID: 33062372 PMCID: PMC7539112 DOI: 10.1155/2020/8828289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Fungemia due to obstructive urinary tract fungal ball is exceedingly rare. These patients often have multiple predisposing conditions, including diabetes or antimicrobial exposure. While candiduria can be relatively common in this population, urinary tract fungal balls are a rare entity. Hospitalists should be aware of this rare complication in patients presenting with funguria. Case Presentation. We present a case of a 44-year-old male with type II diabetes, chronic hepatitis C secondary to injection drug use, and chronic kidney disease who developed a urinary tract fungal ball leading to fungemia and subsequent bilateral chorioretinitis, additionally complicated by emphysematous cystitis and pyelonephritis. Additional invasive treatment options beyond typical antifungals are often required in the case of urinary tract fungal ball, and in this case, bilateral nephrostomy tubes and micafungin were employed. Hospital course was complicated by C. tropicalis fungemia with subsequent bilateral fungal chorioretinitis on dilated fundus exam. This was effectively treated with cyclogyl and prednisolone drops along with bilateral voriconazole injections. Follow-up imaging and cultures showed resolution of fungemia, urinary tract masses, and chorioretinal infiltrates; however, recurrent polymicrobial UTIs continue to be an issue for this patient. Conclusions Special multidisciplinary management is required in the treatment of urinary tract fungal balls with subsequent fungemia, including nephrostomy tubes, antifungal irrigation, ureterorenoscopy, and more powerful antifungals such as amphotericin B and 5-flucytosine. This management draws from a myriad of specialties, including urology, infectious disease, and interventional radiology. Additionally, the literature has demonstrated that only approximately half of patients with fungemia receive an ophthalmologic evaluation. Ophthalmologic and urologic cooperation is essential in the case of obstructive uropathy leading to fungemia as the obstructive uropathy must be relieved and these patients should receive a dilated fundus exam.
Collapse
|
4
|
Candida urinary tract infections in adults. World J Urol 2019; 38:2699-2707. [PMID: 31654220 DOI: 10.1007/s00345-019-02991-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Candiduria is commonly seen in hospitalized patients and most of the patients are asymptomatic, but it may be due to cystitis, pyelonephritis, prostatitis, epididymo-orchitis or disseminated candidiasis. Major risk factors are diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units. Candida urinary tract infections can be caused by hematogenous spread following candidemia, or retrograde route via the urethra. The presence of Candida species in urine in asymptomatic patients does not warrant antifungal therapy except neutropenic patients, very low-birth-weight infants and patients undergoing urologic procedures. Fluconazole is the treatment of choice for symptomatic infections, it achieves high urinary levels. The other azole antifungals and echinocandins do not reach sufficient urine levels. Amphotericin B deoxycholate is the alternative antifungal agent if fluconazole can not be used because of resistance, allergy or failure.
Collapse
|
5
|
Abdeljaleel OA, Alnadhari I, Mahmoud S, Khachatryan G, Salah M, Ali O, Shamsodini A. Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1179-1183. [PMID: 30282963 PMCID: PMC6180954 DOI: 10.12659/ajcr.911113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND 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.
Collapse
Affiliation(s)
| | - Ibrahim Alnadhari
- Division of Urology, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Sara Mahmoud
- Department of Pharmacy, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Garegin Khachatryan
- Division of Urology, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Morshed Salah
- Division of Urology, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Omar Ali
- Division of Urology, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Ahmad Shamsodini
- Division of Urology, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| |
Collapse
|
6
|
Stein J, Latz S, Ellinger J, Fechner G, Safi M, Krausewitz P, Müller S, Weyer K, Müller SC. Fungaemia caused by obstructive renal candida bezoars leads to bilateral chorioretinitis: a case report. BMC Urol 2018; 18:21. [PMID: 29548319 PMCID: PMC5857136 DOI: 10.1186/s12894-018-0335-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Renal fungal bezoars are remarkably rare and mostly occur in immunodeficient patients. Only a small number of cases with immunocompetent patients have been published so far. The published treatment approaches comprised systemic antimycotic therapy and surgical or minimal invasive removal of the fungal balls. In some cases irrigation of the renal duct system with amphotericin B was performed. By obstruction of the urinary tract bezoars can lead to infected hydronephrosis and severe urosepsis with high lethality. Fungaemia can cause fungal colonization in different distant organs. Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. The following report highlights that a co-operation between urologists and ophthalmologists is absolutely indispensible in case of fungaemia. CASE PRESENTATION Hereinafter we describe a case of an immunocompetent 56 years old woman, presenting with flank pain and shivering. The diagnosis turned out to be difficult due to initially negative urine culture. The fungaemia caused by obstructive nephropathy led to bilateral candida chorioretinitis. The patient was treated with intravenous amphotericin b and the bezoar was removed by percutaneous "nephrolitholapaxy". After two months, a follow up revealed the patient felt well, chorioretinal lesions regressed and urine culture did not show any fungal growth. CONCLUSION To the best of our knowledge, this is the first case reporting on obstructive renal bezoars, which lead to haematogenous fungus spread and bilateral chorioretinitis. It points out that extensive ophthalmologic examination should be performed in case of fungaemia even if the patient is not suffering from any visual impairment.
Collapse
Affiliation(s)
- Johannes Stein
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Stefan Latz
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Jörg Ellinger
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Guido Fechner
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Maher Safi
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Philipp Krausewitz
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Simone Müller
- Department of Ophthalmology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Karin Weyer
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Stefan C. Müller
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| |
Collapse
|
7
|
Alobaid K, Faty M, El-Nahas A, Al-Terki A, Khan Z. Renal fungus ball in a patient with retroperitoneal fibrosis: Unique complication in a rare disease. Mycoses 2018; 61:410-416. [DOI: 10.1111/myc.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Khaled Alobaid
- Medical Laboratory Department; Microbiology Unit; Al-Amiri Hospital; Kuwait City Kuwait
| | - Mostafa Faty
- Surgical Department; Urology Unit; Al-Amiri Hospital; Kuwait City Kuwait
| | - Ahmed El-Nahas
- Surgical Department; Urology Unit; Al-Amiri Hospital; Kuwait City Kuwait
| | | | - Zia Khan
- Microbiology Department; Faculty of Medicine; Kuwait University; Safat Kuwait
| |
Collapse
|
8
|
Berlanga GA, Machen GL, Lowry PS, Brust KB. Management of a renal fungal bezoar caused by multidrug-resistant Candida glabrata. Proc AMIA Symp 2016; 29:416-417. [PMID: 27695182 DOI: 10.1080/08998280.2016.11929493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We describe our management of an immunocompetent individual who developed obstructive uropathy and candidemia as a result of a fungal bezoar in the kidney. These sequelae arose from candiduria, provoked after several courses of antibiotics. Successful treatment included therapy with both culture-appropriate intravenous antifungals and operative intervention, including direct irrigation of the affected kidney with amphotericin B, relief of renal obstruction with a ureteral stent, a percutaneous nephrostomy tube, and ultimately endoscopic removal of the fungal bezoar. Our patient was successfully treated as evidenced by negative urine culture and lack of ongoing symptomatology.
Collapse
Affiliation(s)
- Gemma A Berlanga
- Departments of Infectious Diseases (Berlanga, Brust) and Urology (Machen, Lowry), Baylor Scott & White Health, Temple, Texas
| | - Graham L Machen
- Departments of Infectious Diseases (Berlanga, Brust) and Urology (Machen, Lowry), Baylor Scott & White Health, Temple, Texas
| | - Patrick S Lowry
- Departments of Infectious Diseases (Berlanga, Brust) and Urology (Machen, Lowry), Baylor Scott & White Health, Temple, Texas
| | - Karen B Brust
- Departments of Infectious Diseases (Berlanga, Brust) and Urology (Machen, Lowry), Baylor Scott & White Health, Temple, Texas
| |
Collapse
|
9
|
Tiwari V, Hui M, Rai M. Incidence of Candida Species in Urinary Tract Infections and Their Control by Using Bioactive Compounds Occurring in Medicinal Plants. Med Mycol 2015. [DOI: 10.1201/b18707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
10
|
Potenta SE, D'Agostino R, Sternberg KM, Tatsumi K, Perusse K. CT Urography for Evaluation of the Ureter. Radiographics 2015; 35:709-26. [PMID: 25815907 DOI: 10.1148/rg.2015140209] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over the past decade, computed tomographic (CT) urography has emerged as the primary imaging modality for evaluating the urinary tract in various clinical settings, including the initial workup of hematuria. With the widespread implementation of CT urography, it is critical for radiologists to understand normal ureteral anatomy and the varied appearance of pathologic ureteral conditions at CT urography. Pathologic findings at CT urography include congenital abnormalities, filling defects, dilatation, narrowing, and deviations in course. These abnormalities are reviewed, along with the indications for CT urography, current imaging protocols with specific techniques for optimal evaluation of the ureter, and dose reduction strategies.
Collapse
Affiliation(s)
- Scott E Potenta
- From the Department of Radiology (S.E.P., R.D., K.P.), Department of Surgery, Division of Urology (K.M.S.), and Department of Pathology and Laboratory Medicine (K.T.), University of Vermont Medical Center, 111 Colchester Ave, Mailstop 326PA1, Burlington, VT 05401
| | | | | | | | | |
Collapse
|
11
|
O'Kane D, Kiosoglous A, Jones K. Candida dubliniensis encrustation of an obstructing upper renal tract calculus. BMJ Case Rep 2013; 2013:bcr-2013-009087. [PMID: 23975908 DOI: 10.1136/bcr-2013-009087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 53-year-old man, with a history of alcohol abuse, requiring intensive care unit admission, with an obstructing right upper renal calculus and Klebsiella pneumoniae urosepsis. Ureteroscopic treatment of this obstruction displayed a small calculus within the renal pelvis completely encapsulated within a fungal bezoar. Laboratory analysis of the fungal mass found it to be Candida dubliniensis.
Collapse
Affiliation(s)
- Dermot O'Kane
- Department of Urology, Gold Coast Hospital, Southport, Queensland, Australia.
| | | | | |
Collapse
|