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Bladder fungus ball: a reversible cause of neonatal obstructive uropathy
B Baetz-Greenwalt1, B Debaz, M L Kumar
1Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH.
Abstract:
Very low birth weight infants often have multiple predisposing conditions for the development of invasive candidiasis. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungus balls"), usually at the ureteropelvic junction. Ureteropelvic junction obstructive fungal uropathy necessitates invasive debridement to restore renal function. A very low birth weight infant, infected with Candida, was first seen with hypertension, renal insufficiency, and urine cultures positive for fungus; obstructive bladder fungus ball was diagnosed by ultrasonography. Mechanical disruption with amphotericin B bladder irrigation was accomplished via ultrasonographic guidance, relieving renal obstruction and insufficiency. Systemic antifungal therapy was completed with amphotericin B and flucytosine. The first reported case of bladder obstructive fungal uropathy in a neonate is added to a review of 16 cases of neonatal renal obstructive uropathy.
Insights
Very low birth weight infants are susceptible to invasive candidiasis. This study reports a novel case of bladder obstructive fungal uropathy in a neonate, successfully treated with antifungal bladder irrigation.
Area of Science:
- Neonatal medicine
- Pediatric nephrology
- Mycology
Background:
- Very low birth weight infants have multiple risk factors for invasive candidiasis.
- Systemic candidiasis can lead to renal complications like fungal balls, causing obstruction.
Observation:
- A neonate with very low birth weight presented with hypertension, renal insufficiency, and fungal urine cultures.
- Ultrasonography revealed an obstructive fungal ball in the bladder.
Findings:
- Mechanical disruption and amphotericin B bladder irrigation, guided by ultrasonography, resolved the obstruction and improved renal function.
- The infant completed systemic antifungal therapy with amphotericin B and flucytosine.
Implications:
- This is the first reported case of bladder obstructive fungal uropathy in a neonate.
- The findings add to the understanding of neonatal renal obstructive uropathy and its management.