Abstract: SA-PO1224
Trichosporon asahii-Associated Calyceal Rupture
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Cheng, Derek, Temple University, Philadelphia, Pennsylvania, United States
- Patel, Vraj, Temple University, Philadelphia, Pennsylvania, United States
- Rehan, Anam, Temple University, Philadelphia, Pennsylvania, United States
- Lee, Iris J., Temple University, Philadelphia, Pennsylvania, United States
Introduction
Trichosporon Asahii (T. Asahii), an opportunistic fungal pathogen has virulence factors including phospholipase activity, hemolysin production, and biofilm production, which enable colonization of implanted devices and causing infections with a high mortality rate. We present a case of T. Asahii infection associated with calyceal rupture.
Case Description
52 years old male on hemodialysis for high risk APOL1 focal segmental glomerular sclerosis had living related kidney transplant in Ghana which complicated by prolonged urinary leak and E. Coli urosepsis requiring percutaenous nephrostomy (PCN) and 4 weeks of antibiotics. His creatinine (Cr) nadired at 1.2 mg/dL.
His PCN dislodged with development of urine leak recurrence. His imaging suggested pyelonephritis but aspiration negative for culture. Subsequently, he was treated with cefpodoxime and levofloxacin for 4 weeks along with fosfomycin for resistant enterobacter coverage. A month later, he presented with fever and non-bilious emesis. His Cr was mildly elevated to 1.5 mg/dL. His imaging revealed transplant pyelonephritis with fluid collections, concerning for abscesses. Urine culture grew T. Asahii for which he completed 3 days of fluconazole (FLU) prior to internal stent removal. His Cr rose after stent removal with ultrasound revealing worsening hydronephrosis. A foley was placed and tamsulosin was started to rule out bladder outlet obstruction. Tc-99m-mertiatide tracer scan showed delayed excretion of tracer from the renal cortex and stasis of tracer activity at the calyx and pelvis, with partial response to diuretic, consistent with hydronephrosis but no leak was visualized. His Cr rose despite foley and while awaiting repeat PCN, he developed acute abdominal pain with imaging revealing calyceal rupture. Cr rose to 5 and was emergently taken for PCN after which his Cr improved back to 1.2 mg/dL. Culture sent at the time of stent removal re-demonstrated T. Asahii prompting re-initiation of FLU.
Discussion
Biofilm formation on implanted hardware may enable T. Asahii to persist despite an initial FLU course and may warrant a prolonged course of FLU through stent removal. While a complete obstruction could explain spontaneous calyceal rupture, delayed tracer clearance is more consistent with a partial obstruction, and residual T. Asahii infection could have contributed to the calyceal rupture. This case raises our vigilance of Trichosporon especially in immunosuppressed individuals.