title: Aspergillus terreus-related ureteral obstruction in a diabetic patient.
abstract: An Aspergillus fungal ball is a rare cause of ureteral obstruction attributed to indwelling catheters, stents, antibiotics, anastomotic leaks, obstruction, and immunosuppressive therapy and other immunocompromised states. We describe a case of unilateral ureteral obstruction caused by Aspergillus terreus following ureteroscopic lithotripsy and ureteral stenting in a 45-year-old diabetic man. The patient was successfully treated with endoscopic removal of the fungal mass and oral voriconazole. We also review briefly the clinical features, treatment, and outcome in 9 previously reported diabetic patients with ureteral obstruction due to aspergillosis. Obstructive uropathy related to Aspergillus mass may be suspected in diabetic patients with a history of manipulation, impaired kidney function, and persistent passage of a soft mass in urine. Direct microscopy and culture of multiple urine and ureteral washing are necessary for early diagnosis. Antifungal therapy and endoscopic removal of the mass are needed to reduce morbidity.
authors.affiliation: Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Najafi
authors.forename: Tahereh
authors.initials: T
authors.lastname: Shokohi
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Parvin
authors.forename: Davood
authors.initials: D
authors.lastname: Yadegarinia
authors.forename: Faramarz
authors.initials: F
authors.lastname: Taghavi
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Hedayati
authors.forename: Roholah
authors.initials: R
authors.lastname: Abdi
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology*; D001230:Aspergillus / Q000302:isolation & purification*; D048909:Diabetes Complications; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects* / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use; D014513:Ureter / Q000382:microbiology / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole