Abstract: SA-PO372
Invasive Primary Mucormycosis: Renal Rhizopus
Session Information
- Genetic and Diagnostic Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1602 Pathology and Lab Medicine: Clinical
Authors
- Bui, Tina, University of Oklahoma Internal Medicine, Tulsa, Oklahoma, United States
- Girgis, Christopher Hany, The University of Oklahoma - Tulsa, Tulsa, Oklahoma, United States
- Kathuria, Pranay, The University of Oklahoma College of Medicine, Tulsa, Oklahoma, United States
Introduction
Mucormycosis is a known entity among diabetics and immunosuppressed patients.There are cases where the mucormycosis spectrum can involve individual organs, and in this case, the renal system.
Treatment is difficult as this fungus is angio-invasive and can cause tissue infarction, which limits antifungal penetration to the affected tissues. The choice of antifungal therapy has traditionally been set to amphotericin B in regards to mucormycosis, whether in systemic or focal disease.
However, in this case, posaconazole was a successful alternative treatment option to amphotericin.
Case Description
A 49 year white male with chronic kidney disease, uncontrolled diabetes, and a history of IV drug use presented to urgent care with right flank pain, dysuria, and hematuria, sent home with a subsequent visit to the emergency department. Hydronephrosis was noted on the right kidney and a ureteral stent was placed by urology.
2 weeks later, the patient followed up with urology to undergo uretero-renoscopy. However, this was postponed 2 weeks due to severe hyperglycemia. The patient underwent the uretero-renoscopy, revealing amorphous material within the right renal pelvis. MRI revealed a fungus ball with 60 percent of the volume of the right renal parenchyma consistent with pyelonephritis, as well as poor blood flow consistent with renal infarction. Biopsy revealed Rhizopus species, with repeat renal biopsy demonstrating fungal colonization. Urine and blood cultures were negative. The patient was started on posaconazole, as opposed to amphotericin B, due to a relatively normal left kidney and overall clinical stability.
Due to the vascular and parenchymal invasion, nephrectomy was performed with pathology demonstrating extensive fungal pyelonephritis with abscesses. The patient continued with oral posaconazole for any microscopic remnants of the fungus for six weeks and did well with monitoring of CKD and diabetes.
Discussion
In most cases of reported isolated renal Rhizopus, amphotericin and nephrectomy are standard of care with an azole anti-fungal used as step down therapy or therapy in which the patient does not respond to amphotericin.
With utilization of both posaconazole and nephrectomy, alternative to amphotericin B, the patient was able to maintain stable residual kidney function in an infection associated with high mortality and was successfully treated for isolated mucormycosis of the rhizopus group .