Localized primary renal aspergillosis in a diabetic patient following lithotripsy--a case report.
BACKGROUND
Primary renal aspergillosis is rare in diabetic patients. Diagnosis of localized primary renal Aspergillus infection in diabetic patients requires careful investigations due to its benign presentation and lack of associated systemic clinical features. There is also paucity of information on the role of conservative treatment of such localized infection with antifungal agents only. Here, we describe a case of localized renal aspergillosis in a type 2 diabetic patient with a brief review of literature.


METHODS
We describe a case of unilateral renal aspergillosis following intracorporeal pneumatic lithotripsy (ICPL) in a type 2 diabetic man. The patient presented with mild pain in the left lumbar region and periodic expulsion of whitish soft masses per urethra, which yielded growth of Aspergillus fumigatus. He was treated initially with amphotericin B; however, it was stopped after 2 weeks, as he could not tolerate the drug. Subsequently, he was successfully treated with oral itraconazole.


CONCLUSIONS
Localized renal aspergillosis may be suspected in diabetic patients having history of urinary tract instrumentation, mild lumbar pain, passage of suspicious masses in urine and persistent pyuria. Examination of the suspicious substances expelled per urethra is essential for diagnosis as routine multiple urine analysis may yield negative results. Conservative treatment with oral itraconazole alone is effective in cases with incomplete obstruction.
Haq
Jalaluddin A
JA
Department of Microbiology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh. jalaluddin@kck.usm.my
Khan
Mohammad Am
MA
Afroze
Nazma
N
Haq
Tahniyah
T
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000187:drug effects / Q000472:pathogenicity; D048909:Diabetes Complications / Q000382:microbiology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007669:Kidney Calculi / Q000628:therapy; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B