Renal fungus ball: a challenging clinical problem

Area of Science:

• Urology
• Nephrology
• Mycology

Background:

• Fungal balls in the renal pelvis and ureter pose a significant clinical challenge, particularly in diabetic patients with recurrent urinary tract infections.
• This case highlights the management of a complex renal pelvi-ureteric fungus ball caused by Candida albicans.

Observation:

• A 46-year-old male with uncontrolled Type 2 diabetes mellitus presented with recurrent urinary tract infections.
• Imaging revealed a significant fungus ball in the right renal pelvis and proximal ureter, causing severe hydroureteronephrosis and vesicoureteral reflux.
• Initial oral fluconazole therapy was insufficient to resolve the fungal obstruction.

Findings:

• A minimally invasive strategy involving the placement of two nephrostomy tubes was employed.
• Amphotericin B irrigation was administered through one nephrostomy tube, with the other serving for free drainage.
• Complete resolution of the fungus ball was confirmed by antegrade nephrostogram after five days of treatment.

Implications:

• This dual nephrostomy tube and direct antifungal irrigation technique offers a prompt and efficient solution for renal pelvi-ureteric fungus balls.
• The described approach is well-tolerated and facilitates rapid clearance of fungal masses, potentially avoiding more invasive procedures.
• Prompt management of such fungal infections is crucial for successful clinical outcomes and preventing further renal damage.