Dubert Marie, Loi Valeria, Tligui Mohamed, Hertig Alexandre
Urgences Néphrologiques et Transplantation Rénale, APHP, Hopital Tenon, Paris, France.
BMJ Case Rep. 2012 Dec 14;2012:bcr2012007504. doi: 10.1136/bcr-2012-007504.
Antibiotics reduce the commensal flora in the gut, thereby facilitating the overgrowth of undesirable microorganisms such as Candida albicans. Here, we report the case of a 48-year-old woman with a history of obstructive uropathy consecutive to a radiation therapy, in whom both indwelling ureteral stents were rapidly occluded by fungal mycelia, resulting in a rapidly progressive kidney failure. Ascendant infection by C albicans had occurred after a 2- week course of antibiotics, prescribed for a perforative peritonitis also due to radiation-induced colitis. As shown by iterative CT scans made before (at the time of the diagnosis of peritonitis) and after the antibiotic course, kidney failure was explained by a sudden and bilateral pyelocaliceal dilation, due to the obstruction of the ureteral stents. Fungal mycelia were objectivised during the replacement procedure. Intravenous fluconazole was started, and renal function recovered ad integrum with the relief of the obstruction.
抗生素会减少肠道中的共生菌群，从而促使诸如白色念珠菌等不良微生物过度生长。在此，我们报告一例48岁女性病例，该患者有放射治疗后梗阻性尿路病病史，其体内留置的双侧输尿管支架迅速被真菌菌丝阻塞，导致快速进展性肾衰竭。在因放射性结肠炎导致的穿孔性腹膜炎接受为期2周的抗生素治疗后，发生了白色念珠菌上行感染。如在抗生素治疗前（腹膜炎诊断时）及治疗后进行的多次CT扫描所示，肾衰竭是由于输尿管支架阻塞导致双侧肾盂肾盏突然扩张所致。在更换支架过程中发现了真菌菌丝。开始静脉注射氟康唑，随着梗阻解除，肾功能完全恢复。
