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Al-Ibraheem H, Shaker G, Roushias S. Isolated renal aspergilloma. Urol Case Rep 2024; 53:102688. [PMID: 38435122 PMCID: PMC10907385 DOI: 10.1016/j.eucr.2024.102688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Aspergilloma localised solely to the kidneys is very rare and poses diagnostic and therapeutic challenges. We present the case of a 35-year-old male with a background of urolithiasis, type II diabetes and chronic kidney disease, who was found to have isolated renal aspergilloma associated with obstructing uric acid renal tract calculi. After poor progress to clear the fungal infection and remaining stones with ureteroscopy, he was successfully treated by percutaneous nephrolithotomy (PCNL) to surgically remove fungal balls and calculi. Additionally, he was treated with peri-operative oral and systemic antifungals and post-operative irrigation of the renal collecting system with amphotericin.
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Affiliation(s)
- Hasan Al-Ibraheem
- NHS Wales Aneurin Bevan University Health Board, Newport, United Kingdom
| | - George Shaker
- NHS Wales Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Stella Roushias
- NHS Wales Aneurin Bevan University Health Board, Newport, United Kingdom
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Ghasemian R, Vahedi Larijani L, Rasouli K, Hedayati MT, Tavakol C, Heydari K, Zalpoor H, Hoseini A. Renal aspergillosis after COVID-19-associated pulmonary aspergillosis: A case report. Clin Case Rep 2023; 11:e7882. [PMID: 37692155 PMCID: PMC10485246 DOI: 10.1002/ccr3.7882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/12/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Key Clinical Message Renal aspergillosis is a rare condition and this case the first case of Renal aspergillosis reported after COVID-19-associated pulmonary aspergillosis. Renal symptoms should arise clinical suspicion to renal involvement that happened as a result of hematogenous spreading of pulmonary aspergillosis. Abstract Secondary fungal infections are among the most significant complications that can arise after COVID-19 and have the potential to lead to a high rate of morbidity and mortality. As COVID-19 primarily involves the airway, the majority of fungal infections reported have been related to the respiratory system. However, renal aspergillosis that we have reported is a rare condition that also can occur. A 67-year-old man was referred to our hospital and admitted as a COVID-19 patient. After the initial recovery, he experienced a recurrence of fever accompanied by a productive cough. The histopathological studies were conducted on the sputum and bronchoalveolar lavage samples, which revealed the presence of Aspergillus flavus. We treated the patient with voriconazole and the patient was discharged after a period of time. However, after approximately 6 months, he returned to the hospital with a fever and abdominal pain. We started a fever workup. Two new hypoechoic abscess-like masses were spotted in the right kidney in the ultrasonography (U/S) and the direct molecular studies of the biopsy sample obtained under U/S guidance identified Aspergillus flavus. Although renal aspergillosis is a rare condition, it should not be overlooked, especially in patients with severe COVID-19 and pulmonary aspergillosis, as these conditions can lead to renal aspergillosis, which may present with symptoms such as abdominal pain with fever. Therefore, it is necessary to perform radiological and histopathological studies when renal aspergillosis is suspected.
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Affiliation(s)
- Roya Ghasemian
- Department of Infectious DiseaseAntimicrobial Resistance Research Center, Mazandaran University of Medical SciencesSariIran
| | - Lale Vahedi Larijani
- Department of Pathology, School of MedicineMazandaran University of Medical SciencesSariIran
- Gastrointestinal Cancer Research Center, Non‐Communicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Kimia Rasouli
- Student Research Committee, School of MedicineMazandaran University of Medical SciencesSariIran
| | - Mohammad Taghi Hedayati
- Department of Medical Mycology, School of MedicineMazandaran University of Medical SciencesSariIran
- Invasive Fungi Research Center/Department of Medical Mycology, School of MedicineMazandaran University of Medical SciencesSariIran
| | - Chanour Tavakol
- Tehran School of MedicineTehran University of Medical SciencesTehranIran
| | - Keyvan Heydari
- Gastrointestinal Cancer Research Center, Non‐Communicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
- Student Research Committee, School of MedicineMazandaran University of Medical SciencesSariIran
| | - Hamidreza Zalpoor
- Shiraz Neuroscience Research Center, Shiraz University of Medical SciencesShirazIran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN)TehranIran
- American Association of Kidney Patients (AAKP)TampaFloridaUSA
| | - Aref Hoseini
- Student Research Committee, School of MedicineMazandaran University of Medical SciencesSariIran
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Bongomin F, Morgan B, Ekeng BE, Mushi MF, Kibone W, Olum R, Meya DB, Hamer DH, Denning DW. Isolated renal and urinary tract aspergillosis: a systematic review. Ther Adv Urol 2023; 15:17562872231218621. [PMID: 38130371 PMCID: PMC10734358 DOI: 10.1177/17562872231218621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Background Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis. Methods We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August 2023 using the key terms 'renal' OR 'kidney*' OR 'prostate' OR 'urinary bladder' OR 'urinary tract*AND 'aspergillosis' OR 'aspergillus' OR 'aspergilloma' OR 'mycetoma'. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies, protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded. Results We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925-2023. Among the participants, 79 (86.8%) were male, with a median age of 46 years. Predominantly, presentations consisted of isolated renal infections (74 instances, 81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens (p = 0.739) or nephrectomy status (p = 0.8). Conclusion Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management. PROSPERO registration number CRD42023430959.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Bethan Morgan
- Trust Library Services, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Emerging Infectious Disease Laboratory, Boston, MA, USA
- Center for Emerging Infectious Diseases Policy & Research, Boston University, Boston, MA, USA
| | - David W. Denning
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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