Candida albicans renal abscesses predisposed by staghorn calculi

A 73-year-old man with type 2 diabetes mellitus and hypertension presented with fever, lethargy, and reduced oral intake for two weeks. The patient was febrile and hemodynamically stable upon arrival. Otherwise, physical examination results were unremarkable. Blood cultures revealed no growth, whereas urine cultures revealed Candida albicans. Abdominal and pelvic computed tomography (CT) revealed left renal abscesses, left staghorn calculi, and hydroureter (Figure 1). The left renal abscess was aspirated and the pus was drained, revealing Candida albicans, which is sensitive to fluconazole. The patient underwent left retrograde pyelography and ureteric stenting. The patient was initially treated with intravenous fluconazole, followed by oral fluconazole for four weeks. Follow-up CT revealed resolution of the renal abscess.

FIGURE 1:
Computed tomography of the abdomen and pelvis showing well-defined collections in the left kidney resembling abscesses, with the largest collection measuring 3.7 cm × 3.8 cm × 3.9 cm at the lower pole (indicated by arrow).

Renal abscesses caused by Candida albicans, an opportunistic fungal pathogen, are rare but serious manifestations of invasive candidiasis. These abscesses typically occur in immunocompromised individuals such as those with diabetes mellitus, long-term antibiotic use, or urinary tract abnormalities¹. Candida-related renal abscesses are characterized by localized pus pockets within the kidney parenchyma and are frequently accompanied by fever, flank pain, and sepsis^1,2. Early detection using imaging techniques such as CT and prompt antifungal therapy (usually fluconazole) are critical to avoid potential complications such as renal failure or systemic dissemination³.

ACKNOWLEDGEMENTS

None.

REFERENCES

• ¹
  Pappas PG, Lionakis MS, Arendrup MC, Ostrosky-Zeichner L, Kullberg BJ. Invasive candidiasis. Nat Rev Dis Primers. 2018;4:18026.
• ²
  Chang CY, Jayabalan M, Gan YL, Radhakrishnan AP, Ong ELC.Enterococcus hiraebacteremia associated with perinephric collection and renal abscesses in a diabetic woman. Oxf Med Case Reports. 2022;2022(9):omac101.
• ³
  Fisher JF, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infections--treatment. Clin Infect Dis. 2011;52(Suppl 6):S457-66.

• Financial Support: None.

Publication Dates

• Publication in this collection
  13 Oct 2023
• Date of issue
  2023

History

• Received
  30 Aug 2023
• Accepted
  19 Sept 2023