Ureteral obstraction due to Aspergillus terreus in a diabetic patient following ureteroscopic lithotripsy: a case report

B. I. T. A. Mousavi1, N. Najafi2, A. Zeinali2, A. Bassiri3, M. Parvin4, D. Yadegari5, F. Taghavi6, M.T. Hedayati7 and T. Shokohi

Author address: 

1Mazandaran University of Medical Sciences, Iran, 2Department of Infectious Diseases and Dermatology, School of Medicine, Mazandar, Iran, 3Urology and Nephrology Research Center, Shahid Beheshti Univ.Medical Sciences, Iran, 4Dep.Uro.&Patho.,Labba

Abstract: 

Background: Renoureteral aspergillosis following ureteroscopic lithotripsy and insertion of ureteral stent is a rare entity. Due to inadequate sterilization of the instrument during the ureterscopy and insertion of stent, a localized aspergillus infection may occur which may cause pyouria, ureteral obstruction, perinephric abscess and hydronephrosis. Case presentation: We describe a case of unilateral ureteral obstruction caused by Aspergillus terreus following ureteroscopic lithotripsy in a 45-years-old diabetic man. He admitted with complain of passing whitish soft mass along with urine and hydronephrosis in left kidney. Three months prior to hospital admission, he had undergone ureteroscopic lithotripsy for removal of stone and a ureteral stent (DJ catheter) had been placed for 3 weeks. However, due to abnormal discharge and persistent obstruction the stent was changed and prescribed antibiotics for while. As he did not respond to antibiotic treatment, the retrograde pylography was done and removed the stent and placed the new one. In ureteral washing and urine a whitish soft mass were visible and a mesh of fungal hyphae were seen in direct microscopy exam and culture in SDA yielded growth of Aspergillus terreus. He was treated initially with itraconazole; however it was stopped after 25 days due to persistent whitish mass in urine and other sign and symptom. The isolate was susceptible to caspofungin (0.038 lg ml1), posoconazole (0.032 lg ml1), itraconazole (0.032 lg ml1) and voriconazole (0.023 lg ml1) in E-test antifungal susceptibility test. The endoscopic removal of fungal mass was done and
2011

abstract No: 

P063

Full conference title: 

Trends in Medical Mycology, 5th
    • TIMM 5th (2013)