A 52-year-old male, with
diabetes mellitus and
alcoholic liver disease, presented to the Emergency Room for
right flank pain of 3 days' duration, associated with
dysuria. Physical examination revealed right flank tenderness with
fever and
hypotension; laboratory findings showed
acute kidney injury and large blood and leucocytes in the urine. A CT abdomen and pelvis showed
hydronephrosis of the right collecting system of a
horseshoe kidney with air and hyperdense debris in the renal pelvis. Patient was treated for multisensitive Proteus mirabilis emphysematous
pyelonephritis, and a right
nephrostomy tube was inserted. Symptoms recurred in 4 weeks, and repeated urine culture grew Candida albicans and CT scan showed same high density material within the right moiety of the
horseshoe kidney. Patient underwent ureteroscopy, and a white fluffy material was aspirated from the right renal pelvis. Pathology of the aspirate confirmed the presence of fungal balls. Patient was given 2 weeks of oral
fluconazole. Fungal
pyelonephritis is unusual and difficult to treat. Candida species is responsible for the clear majority of the cases. A fungus ball should be managed with surgical and medical
therapy. This patient had an endoscopic procedure to remove the fungus ball and received
fluconazole. His symptoms resolved and urine culture was done before termination of the treatment was negative.