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Isolated bilateral renal mucormycosis in an immunocompetent young male
*For correspondence: kalpesh010385@gmail.com
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 29 yr old male† with no comorbidities presented in the department of Urology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India, in September 2019, with complaints of left flank pain, low-grade fever and oliguria for the preceding 15 days. On examination, the patient was alert, conscious, body mass index 19 kg/m2 and vitals were stable. There was tenderness in the left hypochondriac region. Investigation revealed haemoglobin 7.6 g/dl, total leucocyte counts 24,000/μl, serum potassium 5.9 mEq/l, serum creatinine 7.4 mg/dl, serum pH 7.15, base access, deficit (−18). Urine analysis showed 7-8 pus cells and fungal hyphae on peripheral smear. The patient received two sessions of haemodialysis. Intravenous amphotericin B was started empirically. Contrast-enhanced computed tomography abdomen revealed bilateral non-enhancing kidneys with Class 3 emphysematous pyelonephritis completely replacing the left kidney (Fig. 1A-D). Bilateral nephrectomy was done, and renal artery thrombosis was visualized bilaterally (Fig. 2A-D). Histopathology confirmed multiple broad aseptate hyphae with lack of inflammatory cells and interlobular artery showing fibrin thrombi suggesting angioinvasive nature of mucormycosis (Fig. 3A-D). The patient succumbed in the post-operative period.
- (A-D) Contrast-enhanced computed tomography abdomen axial images showing bilateral non-enhancing globular enlarged kidneys with perinephric inflammation and left emphysematous pyelonephritis replacing the left kidney (arrow).
- (A-D) Intraoperative images during bilateral nephrectomy showing dense adhesions around the kidney and thrombus visualized in the renal artery (arrow).
- (A-D) Haematoxylin- and eosin-stained sections of kidney specimen showing the arterial wall with fibrin thrombi and multiple broad aseptate foldable hyphae with lack of inflammatory cells and infarction of renal parenchyma (arrow).
Acknowledgment:
Authors acknowledge Dr Ujjwal Gorsi, department of Radiology, PGIMER, Chandigarh, for providing high-quality radiology images.
Conflicts of Interest: None.
