Das Manoj Kumar, Rangrajan Pakshi Rajan, Kalra Sidharth, Elumalai Arthi, Theckumparampil Nithin
Department of Urology, All India Institute of Medical Science, Bhubaneswar, India.
Department of Urology, Pondicherry Institute of Medical Science, Puducherry, India.
J Endourol Case Rep. 2019 Dec 2;5(4):167-170. doi: 10.1089/cren.2019.0012. eCollection 2019.
Fungal masses (fungal ball or bezoars) rarely present as renal calculus. More so, Trichosporon species are even more uncommon among the noncandidial fungal infections affecting urinary tract. We report two such interesting cases that are not yet reported in the current literature. Our first case is a 48-year-old gentleman with diabetes presented with fever and flank pain. He was found to have bilateral obstructing radiolucent renal calculi with azotemia. Initially managed with bilateral Double-J stenting after one session of hemodialysis, and subsequently bilateral percutaneous nephrolithotomy (PCNL) was accomplished. Our second patient is a 37-year-old lady presented with bilateral flank pain with no comorbidity or sepsis. On evaluation, she was found to have bilateral radiolucent staghorn calculi and for which bilateral PCNL was performed. In view of high suspicion of fungal infection, extracted soft floppy materials were sent for fungal culture and were treated with antifungal agents after Trichosporon species was detected. Although renal fungal infections are rare, a strong suspicion and timely definitive management of such entities in patients with radiolucent renal calculus can prevent devastating invasive disease.
真菌团块（真菌球或粪石）很少表现为肾结石。更确切地说，在影响尿路的非念珠菌性真菌感染中，毛孢子菌属更为罕见。我们报告两例此类有趣的病例，目前文献中尚未有报道。我们的首例病例是一名48岁患有糖尿病的男性，表现为发热和侧腹痛。他被发现双侧存在透光性梗阻性肾结石并伴有氮质血症。最初在进行了一次血液透析后进行了双侧双J管置入术，随后完成了双侧经皮肾镜取石术（PCNL）。我们的第二例患者是一名37岁女性，表现为双侧侧腹痛，无合并症或脓毒症。经评估，她被发现双侧存在透光性鹿角形结石，并为此进行了双侧PCNL。鉴于高度怀疑真菌感染，取出的柔软松散物质被送去进行真菌培养，在检测到毛孢子菌属后用抗真菌药物进行了治疗。虽然肾真菌感染很少见，但对于透光性肾结石患者，对此类情况保持高度怀疑并及时进行明确处理可预防严重的侵袭性疾病。
