We present the first reported case of Candida
pyelonephritis in a spinal cord injured patient. In addition to multiple courses of empiric
antibiotics, the
neurogenic bladder and alteration in cell-mediated immunity found in spinal cord injured patients may have increased this patient's susceptibility to
fungal disease. A 50-year-old patient with C5 motor functional
quadriplegia developed Candid albicans
pyelonephritis while undergoing rehabilitation. The patient had several
surgical procedures and multiple courses of
antibiotic therapy during acute hospitalization. He continued to have a hectic
fever curve,
leukocytosis with increased band forms,
lethargy, and progressive
uremia during rehabilitation. Successful investigation of the patient's condition included assessment of serologic tests for Candida precipitin
antigen; multiple blood and urine cultures; exclusion of other causes of hectic
fever; abdominal computerized tomogram, which revealed a left kidney hypodensity with irregular margins; and a retrograde pyelogram, which demonstrated multiple renal pelvic-filling defects. Cystoscopically placed ureteral
stents, which relieved the genitourinary obstruction, drained gross
pus from which Candida albicans was cultured; the patient was treated with
amphotericin B and showed clinical improvement. Pathogenesis, presentation, diagnosis, and treatment of Candida
pyelonephritis are reviewed.