Fatal renal mucormycosis in an apparently healthy young man
Mucormycosis is a rare fungal infection, encountered primarily in immunocompromised patients. It is the third most common angioinvasive fungal infection after candidiasis and aspergillosis. Isolated mucormycosis of the kidney may be seen in patients with diabetes or renal transplantation, but such an occurrence in apparently healthy immunocompetent patients is extremely rare.

Published in the American Journal of Clinical Pathology, the authors present a case of a 35-year-old male with no known comorbidities who presented with a 4-day history of left flank pain, hematuria, and fever, followed by nausea, vomiting, and constipation. CT abdomen revealed left kidney upper and mid-pole lobar nephronia complicated by infarction. Left nephrectomy revealed a distorted left kidney that, on microscopic examination, showed entirely necrotic and hemorrhagic renal parenchyma with marked acute inflammation and abscess formation.

Within many of the necrotic areas, aseptate fungal hyphae, suggestive of mucor, were noted. Some of the blood vessels were thrombosed and contained aggregates of the fungal hyphae within the lumina and invading vessel walls. Antifungal treatment was started, but the patient’s condition continued to deteriorate, and the follow-up CT scan revealed multiple levels of vascular occlusion, involving the mesenteric vessels as well as contralateral kidney infarction.

These findings were suggestive of dissemination of the fungal infection. The patient developed generalized edema and renal and respiratory failure and died on 20th day of hospitalization. PCR study on a tissue block from nephrectomy specimen identified the fungus as Apophysomyces elegans.

Lessons learnt:-
- This case report serves to highlight the possibility of fungal infection, especially A elegans, in the setting of isolated renal infection even in immunocompetent patients.

- These infections, unless treated early, may progress rapidly and have a high mortality rate.

Source: https://pxmd.co/12r4a
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