Primary renal aspergillosis and xanthogranulomatous pyelonephritis in an immuno-competent toddler

Area of Science:

• Nephrology
• Mycology
• Pediatric Infectious Diseases

Background:

• Renal aspergillosis is typically secondary to pulmonary infection via hematogenous spread.
• Primary renal aspergillosis is rare, predominantly affecting immunocompromised individuals.
• Complications include abscesses, fungal bezoars, and ureteric obstruction.

Observation:

• A 2-year-old immunocompetent child presented with sepsis and acute renal failure.
• The child had localized primary renal aspergillosis with significant fungal bezoar formation.
• The affected kidney showed signs necessitating nephrectomy for xanthogranulomatous pyelonephritis.

Findings:

• Successful management of primary renal aspergillosis was achieved through nephroscopic fungal bezoar removal.
• Intravenous voriconazole administration was a key component of the antifungal treatment strategy.
• The case demonstrates a rare occurrence in an immunocompetent pediatric patient.

Implications:

• This case expands the understanding of primary renal aspergillosis presentation and management in children.
• It underscores the importance of considering fungal infections even in immunocompetent hosts with severe renal symptoms.
• Successful nephroscopic intervention combined with systemic antifungals offers a viable treatment approach for complex renal fungal bezoars.