Abstract: SA-PO0353
When Pyelonephritis Reaches the Lung: A Candida-Associated Nephrobronchial Fistula
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Tope, Rutvij Amol, Deenanath Mangeshkar Hospital and Research Centre, Pune, MH, India
- Barik, Nivedita, Apollo Hospitals Enterprise Limited, Chennai, TN, India
Introduction
Nephrobronchial fistula (NBF) is an uncommon pathological communication between the kidney and bronchial tree, most often resulting from chronic bacterial renal infections. Fungal involvement is exceptionally rare and scarcely described. We report a case of NBF in an uncontrolled diabetic patient, where renal abscess culture grew both Klebsiella pneumoniae and Candida albicans.
Case Description
A 40-year-old woman presented with productive cough, unintentional weight loss, and oral thrush. She had poorly controlled diabetes mellitus and a prior episode of left-sided pyelonephritis treated conservatively, after which she was lost to follow-up. HIV ELISA was negative.
Laboratory evaluation showed leukocytosis (16,150/mm3), pyuria, fasting blood glucose of 204 mg/dL, postprandial glucose of 413 mg/dL, and HbA1c of 7.9%.
Delayed-phase CECT demonstrated multi-pole left renal abscesses communicating with the psoas muscle and pleural space, with contrast opacification of segmental bronchi confirming a fistulous tract to the left upper pole calyces.
CT-guided drainage and culture of the renal abscess yielded Klebsiella pneumoniae and Candida albicans. Appropriate antibiotics and antifungals were initiated. She was discharged but subsequently lost to follow-up.
Discussion
NBF is a rare complication of severe renal infection. NBF is initially managed conservatively, but definitive treatment involves nephrectomy.
Although bacterial pathogens are most commonly implicated, this is, to our knowledge, only the second reported case of NBF with confirmed Candida isolation. Since both Klebsiella and Candida were cultured, the primary causative pathogen remains uncertain.
NBF should be considered in patients with renal infections who develop respiratory symptoms. Fungal pathogens should be suspected in high-risk patients (uncontrolled diabetes, oral thrush etc.).