title: Renal Allograft Aspergillus Infection Presenting With Obstructive Uropathy: A Case Report.
abstract: BACKGROUND
  Isolated renal allograft aspergillosis is rare and usually presents with fever and decreased glomerular filtration rate. Presentation with obstructive uropathy caused by aspergillus fungal balls is much less common. We report a young male patient who presented with obstructive uropathy secondary to isolated renal allograft aspergillus infection 6 weeks after transplant. He was treated with nephrectomy and antifungal medications.
  
  
  METHODS
  A 29-year-old Saudi male patient had a recent living non-related kidney transplantation in Pakistan. Early Post-transplant course was complicated by acute cellular rejection (Banff Class IB) which was managed successfully with pulse steroid and anti-thymocyte globulin. The patient presented again to our emergency room on fortieth day post-transplant with a complaint of decreased urine output and passing white particles in his urine. This presentation was three Three weeks after treatment for cellular rejection, the urine fungal culture showed growth of Aspergillus fumigatus, and ultrasound imaging of the allograft kidney revealed mild to moderate hydronephrosis with echogenic materials within the renal pelvis. Biopsy of the transplanted kidney showed severe necrotizing granulomatous inflammation and fungal elements consistent with aspergillus species. The patient was given voriconazole as an antifungal agent and was weaned from immunosuppressive medication. The patient eventually required intermittent hemodialysis and underwent surgical allograft nephrectomy.
  
  
  CONCLUSIONS
  Suboptimal environmental and infection prevention and control precautions can explain this type of infection. It is important for clinicians to have a high index of suspicion and to investigate for fungal infection as a rare cause of obstructive uropathy in high-risk patients.
authors.affiliation: King Abdulaziz Medical City, Western Region, Jeddah, Saudi Arabia.
authors.forename: L
authors.initials: L
authors.lastname: Sadagah
authors.affiliation: King Abdulaziz Medical City, Western Region, Jeddah, Saudi Arabia; University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Alharbi
authors.affiliation: King Abdulaziz Medical City, Central Region, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Alshomrani
authors.affiliation: King Abdulaziz Medical City, Western Region, Jeddah, Saudi Arabia; King Saud Bin Abdulaziz University, Saudi Arabia. Electronic address: malkia02@ngha.med.sa.
authors.forename: A
authors.initials: A
authors.lastname: Almalki
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy*; D001230:Aspergillus; D001232:Aspergillus fumigatus; D006084:Graft Rejection / Q000517:prevention & control; D006099:Granuloma / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000628:therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D009392:Nephrectomy; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D014184:Transplantation, Homologous; D014517:Ureteral Obstruction / Q000150:complications / Q000628:therapy*; D014552:Urinary Tract Infections / Q000150:complications / Q000628:therapy*; D065819:Voriconazole / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D065819:Voriconazole