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Abstract: FR-PO104

A Novel Case of Renal Mucormycosis Associated With Empagliflozin Use

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Haseeb, Abdul, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Abu-Rmaileh, Muhammad, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Penfield, Jeffrey G., VA North Texas Health Care System, Dallas, Texas, United States
  • Liu, Hao, VA North Texas Health Care System, Dallas, Texas, United States
  • Van Buren, Peter N., VA North Texas Health Care System, Dallas, Texas, United States
  • Lederer, Eleanor D., VA North Texas Health Care System, Dallas, Texas, United States
  • Lederer, Swati, VA North Texas Health Care System, Dallas, Texas, United States
Introduction

Renal mucormycosis is a rare but often fatal disease. We describe the first case of renal mucormycosis associated with use of empagliflozin, a sodium glucose cotransporter-2 (SGLT2) inhibitor, in a diabetic patient.

Case Description

63-year-old gentleman with uncontrolled diabetes, hypertension, and hepatitis C liver cirrhosis presented to the Emergency Department with left flank pain. He was on empagliflozin for diabetes mellitus. He was hemodynamically stable. Initial laboratory investigations revealed acute renal failure with a creatinine of 1.7 mg/dl (baseline 0.9 mg/dl). His HbA1c was 12.8%. Urine culture was negative. Imaging revealed left hydronephrosis with perinephric fat stranding. The presumptive diagnosis was a kidney stone but repeat imaging revealed emphysematous cystitis, left hydronephrosis with extensive pyelitis. Broad spectrum antibiotics were started, and a left percutaneous nephrostomy (PCN) tube was placed. A repeat urine culture from the left nephrostomy tube grew mold, of uncertain significance. The culture later speciated zygomycetes and posaconazole was initiated. Repeat imaging was concerning for liquefactive necrosis of the left kidney and an obliterated left ureter. New right-sided hydronephrosis developed, requiring right PCN tube. Liposomal amphotericin was started. He underwent left nephroureterectomy, partial cystectomy, with removal of both PCN tubes and placement of a right ureteral stent. Final microbiologic diagnosis was invasive mucormycosis. He was treated initially with both amphotericin and posaconazole, followed by posaconazole alone for a planned duration of 6-months.

Discussion

This is the first reported case of renal mucormycosis in the setting of SGLT2 inhibitor use. Patient’s risk factors for infection were liver cirrhosis, uncontrolled diabetes, and SGLT2 inhibitor use. The successful outcome was due to the combination of aggressive antifungal therapy and surgery. SGLT2 inhibitors, commonly prescribed for their beneficial effects on cardiovascular and renal outcomes in diabetic patients, are well-tolerated but are associated with a risk of urinary tract infections (UTIs). Though UTIs are most frequently bacterial, rare and atypical organisms can occur, as was seen in this case. Providers should maintain a high index of suspicion when unexpected culture results are obtained.