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Invasive Urinary Tract Aspergillosis: A Rare Entity
Ahmed Amine Jaouahar1, Zakaria Chahbi2, Omar Maoujoud1
1Nephrology and Hemodialysis, Avicenna Military Hospital, Marrakesh, MAR.
Abstract:
We report a rare case of severe acute kidney injury (AKI) due to invasive urinary aspergillosis in a 59-year-old male. Our patient underwent extracorporeal shock wave lithotripsy (ESWL) for bilateral renal calculi followed by bilateral ureteral stent placement. Initially, urine bacteriological cultures were sterile, and renal function was normal. Days later, he developed rapidly progressive oligo-anuric AKI requiring hemodialysis. Despite stent replacement and empirical antibiotics, infection markers continued to rise, and the newly replaced stents became obstructed for the second time. Ureteroscopy-guided urine culture identified Aspergillus fumigatus. A few days after the initiation of voriconazole therapy, the patient demonstrated significant clinical and biological improvement, including urine clarification and normalization of renal function. This case highlights the need to consider fungal infections in persistent unexplained obstructive AKI and underscores the importance of early diagnosis and antifungal therapy.
Insights
A rare case of severe acute kidney injury (AKI) caused by invasive urinary aspergillosis is presented. Early diagnosis and antifungal therapy with voriconazole led to significant clinical improvement and kidney function recovery.
Area of Science:
- Nephrology
- Mycology
- Infectious Diseases
Background:
- Extracorporeal shock wave lithotripsy (ESWL) and ureteral stent placement are common procedures for renal calculi.
- Urinary tract infections are typically bacterial, with fungal infections being less common.
Observation:
- A 59-year-old male developed severe acute kidney injury (AKI) with anuria after ESWL and bilateral ureteral stent placement.
- Despite interventions for presumed bacterial infection, the patient's condition rapidly worsened, with recurrent stent obstruction.
Findings:
- Ureteroscopy-guided urine culture identified Aspergillus fumigatus, indicating invasive urinary aspergillosis.
- Initiation of voriconazole therapy resulted in rapid clinical and biological improvement, including normalization of renal function.
Implications:
- This case underscores the importance of considering fungal infections, specifically invasive urinary aspergillosis, in patients with unexplained obstructive AKI.
- Early diagnosis and prompt antifungal treatment are crucial for successful management and recovery of renal function in such rare cases.
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