Beyond Candida: A clinical insight into rare fungal pyelonephritis in urological practice

Non-Candida fungal infections of the urinary tract, such as Aspergillus and Mucor, though uncommon, pose significant diagnostic and therapeutic challenges. Their variable presentation, antifungal resistance, and frequent association with immunocompromised states or prior instrumentation necessitate a high index of suspicion. This study aims to describe the clinical profile, diagnostic approach, and management outcomes of non-Candida fungal pyelonephritis in urological practice.

A retrospective observational analysis was conducted on four patients diagnosed with non-Candida fungal pyelonephritis at a tertiary urology centre between April 2024 and April 2025. Patients with urine cultures positive for fungi other than Candida were included. Data on clinical features, comorbidities, imaging findings, microbiology, intraoperative observations, treatment modalities, and outcomes were reviewed. Diagnosis was confirmed through culture and/or histopathology, and management was coordinated with infectious disease specialists.

Four patients (three males, one female; age 37-72 years) were identified - three with Aspergillus and one with Mucor infection. Diabetes mellitus was the predominant comorbidity (3/4), and two patients had a history of prior urological instrumentation. Presentations ranged from incidental findings to pyelonephritis with fever and flank pain. Individualized management included minimally invasive percutaneous nephrolithotomy, pyeloplasty, percutaneous nephrostomy insertion, or nephrectomy. All patients responded to therapy, with infection clearance and preserved or improved renal function on follow-up. No mortality was observed.

Non-Candida fungal pyelonephritis, though rare, requires early diagnosis and individualized surgical and antifungal management. Multidisciplinary collaboration ensures favourable outcomes and renal preservation.