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Histoplasmosis of kidneys presenting as chronic recurrent renal disease
S S Kedar1, S Eldar, J Abrahamson
1Department of Urology, Haifa Medical Center (Rothschild), Israel.
Abstract:
Histoplasmosis is a well-known infectious disease that can sometimes run a mysterious and unexpected course. A case is reported that presented as a chronic renal process, with right pyelocutaneous fistula and prolonged purulent discharge as well as focal calcifications of the left kidney with recurrent stone formation. Histopathologic examination of the right kidney, removed in 1975, showed noncaseating granulomas, but the precise diagnosis was not made until 1983, when histopathologic re-examination followed partial resection of the left kidney, for recurrent stone formation. This article emphasizes the difficulty in diagnosing a noncaseating granulomatous disease in general and histoplasmosis in particular, especially when the urogenital tract is involved, with isolated local manifestations. It underlines the progressive and damaging character of this chronic disease, the variety of its manifestations, and attempts to increase awareness of this potentially treatable disease.
Insights
This case report highlights a challenging diagnosis of histoplasmosis (a fungal infection) presenting as chronic kidney disease with unusual urinary tract symptoms. Early recognition is key for treating this progressive, potentially curable condition.
Area of Science:
- Infectious Diseases
- Nephrology
- Medical Mycology
Background:
- Histoplasmosis is an infectious disease caused by the fungus Histoplasma capsulatum.
- Urogenital histoplasmosis can present with varied and subtle clinical manifestations.
- Noncaseating granulomatous inflammation poses diagnostic challenges, particularly in isolated organ involvement.
Observation:
- A patient presented with a chronic renal process involving a right pyelocutaneous fistula, purulent discharge, and left kidney calcifications with recurrent stone formation.
- Initial histopathology of the right kidney (1975) revealed noncaseating granulomas, but the diagnosis of histoplasmosis was delayed until 1983.
- Diagnosis was confirmed after partial resection of the left kidney for recurrent stone formation, necessitating histopathologic re-examination.
Findings:
- The case underscores the diagnostic difficulties associated with noncaseating granulomatous diseases, specifically histoplasmosis, in the urogenital tract.
- Histoplasmosis can manifest with progressive, damaging, and varied localized symptoms, mimicking other renal pathologies.
- Delayed diagnosis can impede timely and effective treatment of this treatable infectious disease.
Implications:
- Increased awareness of atypical presentations of histoplasmosis is crucial for clinicians, especially in nephrology and infectious disease specialties.
- Prompt diagnosis and treatment of urogenital histoplasmosis can prevent significant renal damage and complications.
- This case emphasizes the importance of thorough histopathologic evaluation and considering fungal infections in complex renal cases.