Bilateral renal fungal bezoars in a preterm infant: case report and literature review

Renal fungal bezoars or fungal balls is a rare condition in neonates and infants, usually occurring in immunocompromised patients. Renal bezoars result from accumulations of fungal cells and renal epithelial cells. The most common manifestation is candiduria, which can cause urinary tract obstruction. The treatment of choice is prompt medical or surgical intervention, as indicated to eliminate the infection and preserve renal function. Herein we report the case of a 34-week preterm male infant who presented with feeding intolerance, fever, acute kidney injury and alteration of consciousness. His initial creatinine was 3.4 mg/dL and urine analysis showed pyuria and yeast cells. A renal ultrasound demonstrated a dilated bilateral renal pelvis and calyx with bilateral fungal bezoars. The management was intravenous fluconazole with bilateral nephrostomy tubes and later surgical removal of bilateral fungal balls.