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Kidney Week

Abstract: FR-PO107

Disseminated Lomentospora Infection Presenting as AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Epperson, Katrina, University of California San Diego, La Jolla, California, United States
  • Perens, Elliot, University of California San Diego, La Jolla, California, United States
  • Ruiz, Christina, University of California San Diego, La Jolla, California, United States
  • Shayan, Katayoon, Rady Children's Hospital San Diego, San Diego, California, United States
  • Tovar Padua, Leidy, University of California San Diego, La Jolla, California, United States
  • Carter, Caitlin E., University of California San Diego, La Jolla, California, United States
Introduction

Acute kidney injury (AKI) is a common complication of childhood leukemia and its treatment. One month after induction chemotherapy, the patient developed AKI without another obvious nephrotoxic insult, and a kidney biopsy showed angioinvasive fungus. He was found to have disseminated Lomentospora prolificans and succumbed to the infection. Invasive fungal infection commonly causes multiorgan dysfunction from infection, but AKI is an uncommon initial presentation.

Case Description

An 18yo male with trisomy 21 developed rapidly progressive AKI approximately after initiation of induction chemotherapy (vincristine, cytarabine, methotrexate, and PEG-asparaginase) for newly diagnosed leukemia. He developed non-oliguric AKI with a rise in serum creatinine from 0.75 to 3.7 mg/dL over 72 hours without hemodynamic instability, nephrotoxic medication exposure, or other evident cause of AKI. Evaluation for underlying causes of AKI, including urine microscopy and renal and renovascular ultrasound, were not diagnostic. Kidney biopsy demonstrated acute fungal tubulointerstitial disease. Brain MRI showed multiple lesions concerning for angioinvasive fungal disease. Plasma metagenomic next-generation sequencing identified Lomentospora prolificans. Due to the extensive multiorgan involvement, it was determined that infection was not curable and family opted to withdraw care. Postmortem blood, urine, skin tissue, and spinal fluid were positive for Lomentospora.

Discussion

Our patient suffered severe rapidly progressive AKI as the presenting finding of Lomentospora prolificans infection, a ubiquitous multi-drug resistant environmental filamentous fungi with very high mortality. His risk factors for Lomentospora disseminated disease included leukemia and chemotherapy-induced neutropenia. Treatment for localized Lomentospora includes excision of infected tissue and antifungal therapy, however disseminated disease is often fatal, as it was in this case.

PAS (a) and GMS (b) light micrographs demonstrating acute fungal infection of the kidney with numerous fungal organisms in multiple forms.