Multifocal Renal Fungal Abscesses.

Area of Science:

• Nephrology
• Infectious Diseases
• Mycology

Background:

• Fungal renal abscesses are uncommon, particularly multifocal presentations.
• Patients with diabetes and intravenous substance use disorder are at increased risk for invasive fungal infections.
• Fungal fungemia can lead to disseminated disease, including renal involvement.

Observation:

• A 36-year-old woman with diabetes and intravenous substance use disorder presented with fever and hematuria.
• Blood cultures revealed bacteremia and fungemia.
• Imaging demonstrated multiple fungal renal abscesses unresponsive to initial broad-spectrum antibiotic and antifungal therapy.

Findings:

• Nephrectomy was performed due to persistent fever and lack of improvement in renal abscesses despite medical management.
• Post-nephrectomy, the patient's fever resolved, and follow-up blood cultures were negative.
• This case underscores the challenges in managing refractory multifocal fungal renal abscesses.

Implications:

• Surgical intervention, such as nephrectomy, may be a necessary treatment option for multifocal fungal renal abscesses that do not respond to medical therapy.
• Further research is needed to establish optimal management guidelines for this rare clinical presentation.
• Early recognition and aggressive treatment are crucial for improving outcomes in patients with invasive fungal kidney infections.