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Aspergillus terreus-related ureteral obstruction in a diabetic patient

Narges Najafi1, Tahereh Shokohi, Abbas Basiri

  • 1Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Iranian Journal of Kidney Diseases
|March 15, 2013
PubMed

Insights

Aspergillus fungal balls can cause rare ureteral obstruction, particularly in diabetics after procedures. Early diagnosis via microscopy and culture, followed by antifungal treatment and endoscopic removal, improves outcomes.

Area of Science:

  • Urology
  • Mycology
  • Infectious Diseases

Background:

  • Aspergillus fungal balls are an uncommon cause of ureteral obstruction.
  • Risk factors include indwelling catheters, stents, immunosuppression, and diabetes mellitus.
  • This case highlights a diabetic patient with Aspergillus terreus ureteral obstruction post-ureteroscopic lithotripsy.

Observation:

  • A 45-year-old diabetic male presented with unilateral ureteral obstruction.
  • The obstruction was caused by Aspergillus terreus, a fungal mass.
  • The patient had undergone ureteroscopic lithotripsy and ureteral stenting.

Findings:

  • Successful treatment involved endoscopic removal of the fungal mass and oral voriconazole.
  • A review of 9 previous diabetic cases with ureteral aspergillosis was conducted.
  • Key diagnostic indicators include impaired kidney function and passage of soft masses in urine.

Implications:

  • Aspergillus-related obstructive uropathy should be suspected in diabetic patients with relevant histories.
  • Prompt diagnosis requires direct microscopy and culture of urine and ureteral washings.
  • Combined antifungal therapy and endoscopic mass removal are crucial for reducing patient morbidity.

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