Abdeljaleel Osama Abdelhaleem, Alnadhari Ibrahim, Mahmoud Sara, Khachatryan Garegin, Salah Morshed, Ali Omar, Shamsodini Ahmad
Division of Urology, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar.
Department of Pharmacy, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar.
Am J Case Rep. 2018 Oct 4;19:1179-1183. doi: 10.12659/AJCR.911113.
BACKGROUND Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection. In debilitated or immunosuppressed septic patients, who have upper urinary tract obstruction with renal filling defect, fungal infection should be considered. We report on a patient with sepsis and renal fungal ball who was treated with percutaneous nephrostomy and intravenous antifungal agent, but the patient did not respond so instillation of fluconazole through nephrostomy was given. CASE REPORT A 60-year-old male patient with a known case of diabetes mellitus with refractory urine retention underwent transurethral resection of the prostate. Postoperatively, the patient developed recurrent high-grade fever with left loin pain, and elevated septic parameters; urine and blood culture were positive for Candida albicans. Computed tomography urography showed left hydronephrosis with filling defect in the left renal pelvis with suspected renal fungal ball. Left percutaneous nephrostomy was performed and intravenous fluconazole started but the fever did not subside, therefore, the treatment was changed to anidulafungin. The patient improved but urine from both the bladder and the nephrostomy remained positive for candida. Instillation of fluconazole at 300 mg in 500 mL normal saline was applied through the nephrostomy tube over 12 hours at 40 mL/hour for 7 days. CONCLUSIONS Renal fungal ball is rare but can be serious, especially in immunocompromised patients. Management options for renal fungal ball include intravenous antifungal agents and percutaneous nephrostomy with antifungal instillation of antifungal agents. The objective of this case report was to document treatment success with the use of fluconazole instillation through a nephrostomy tube.
尿路念珠菌感染可能是由于该生物体的血行播散或逆行感染所致。在体弱或免疫抑制的脓毒症患者中，若存在上尿路梗阻并伴有肾充盈缺损，则应考虑真菌感染。我们报告一例患有脓毒症和肾真菌球的患者，该患者接受了经皮肾造瘘术和静脉注射抗真菌药物治疗，但患者无反应，因此通过肾造瘘术给予氟康唑灌注治疗。
一名60岁男性患者，已知患有糖尿病且伴有难治性尿潴留，接受了经尿道前列腺切除术。术后，患者出现反复高热伴左腰部疼痛，脓毒症指标升高；尿液和血液培养白色念珠菌呈阳性。计算机断层扫描尿路造影显示左肾积水，左肾盂有充盈缺损，怀疑有肾真菌球。进行了左经皮肾造瘘术并开始静脉注射氟康唑，但发热未消退，因此将治疗改为使用阿尼芬净。患者病情有所改善，但膀胱和肾造瘘口的尿液念珠菌仍呈阳性。通过肾造瘘管以40毫升/小时的速度在12小时内将300毫克氟康唑溶于500毫升生理盐水中进行灌注，持续7天。
肾真菌球罕见但可能很严重，尤其是在免疫功能低下的患者中。肾真菌球的治疗选择包括静脉注射抗真菌药物以及经皮肾造瘘术并进行抗真菌药物灌注。本病例报告的目的是记录通过肾造瘘管使用氟康唑灌注治疗成功的案例。
