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Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhanced helical CT and MRI findings

C P Heussel1, H U Kauczor, G Heussel

  • 1Department of Radiology, Johannes Gutenberg University, Mainz, Germany. heussel@mail.uni-mainz.de

European Radiology
|June 4, 1999
PubMed

Insights

Magnetic resonance imaging (MRI) is a valuable tool for investigating kidney infections in immunocompromised patients, particularly those with AIDS. This case highlights a unique presentation of renal abscesses caused by Aspergillus fumigatus, effectively diagnosed using advanced MRI techniques.

Area of Science:

  • Radiology
  • Infectious Diseases
  • Immunocompromised Hosts

Background:

  • X-ray contrast agents pose risks like renal insufficiency and allergic reactions in immunocompromised patients (e.g., neutropenic, AIDS patients).
  • Magnetic resonance imaging (MRI) offers better contrast agent tolerance, making it suitable for investigating parenchymal organs in these vulnerable populations.

Observation:

  • An allergic AIDS patient presented with fever and flank pain, initially suspected as simple renal cysts via sonography.
  • T2-weighted MRI revealed high signal intensity in the center of the lesions, with dynamic contrast-enhanced MRI showing an enhancing rim and ill-defined margins, suggesting multiple bilateral abscesses.

Findings:

  • Delayed enhancement of adjacent renal parenchyma on dynamic contrast-enhanced MRI indicated accompanying local pyelonephritis.
  • CT-guided biopsy confirmed Aspergillus fumigatus as the causative microorganism.
  • The specific MR appearance of this invasive renal aspergillosis manifestation was previously undescribed.

Implications:

  • Advanced MRI techniques, particularly dynamic contrast-enhanced sequences, are crucial for accurate diagnosis of complex renal infections in immunocompromised patients.
  • This case expands the understanding of renal manifestations of invasive aspergillosis and their characteristic imaging findings.
  • MRI provides a safer and more informative alternative to X-ray contrast agents for evaluating renal pathology in immunocompromised individuals.

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