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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 85-86

Isolated bilateral renal mucormycosis in an immunocompetent young male


Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission18-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Kalpesh Parmar
Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2137_19

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How to cite this article:
Ranjan KR, Parmar K. Isolated bilateral renal mucormycosis in an immunocompetent young male. Indian J Med Res 2020;152, Suppl S1:85-6

How to cite this URL:
Ranjan KR, Parmar K. Isolated bilateral renal mucormycosis in an immunocompetent young male. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:85-6. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/85/316710

Patient's consent obtained to publish clinical information and images.


A 29 yr old male with no comorbidities presented in the department of Urology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India, in September 2019, with complaints of left flank pain, low-grade fever and oliguria for the preceding 15 days. On examination, the patient was alert, conscious, body mass index 19 kg/m2 and vitals were stable. There was tenderness in the left hypochondriac region. Investigation revealed haemoglobin 7.6 g/dl, total leucocyte counts 24,000/μl, serum potassium 5.9 mEq/l, serum creatinine 7.4 mg/dl, serum pH 7.15, base access, deficit (−18). Urine analysis showed 7-8 pus cells and fungal hyphae on peripheral smear. The patient received two sessions of haemodialysis. Intravenous amphotericin B was started empirically. Contrast-enhanced computed tomography abdomen revealed bilateral non-enhancing kidneys with Class 3 emphysematous pyelonephritis completely replacing the left kidney [Figure 1]A, [Figure 1]B, [Figure 1]C, [Figure 1]D. Bilateral nephrectomy was done, and renal artery thrombosis was visualized bilaterally [Figure 2]A, [Figure 2]B, [Figure 2]C, [Figure 2]D. Histopathology confirmed multiple broad aseptate hyphae with lack of inflammatory cells and interlobular artery showing fibrin thrombi suggesting angioinvasive nature of mucormycosis [Figure 3]A, [Figure 3]B, [Figure 3]C, [Figure 3]D. The patient succumbed in the post-operative period.
Figure 1: (A-D) Contrast-enhanced computed tomography abdomen axial images showing bilateral non-enhancing globular enlarged kidneys with perinephric inflammation and left emphysematous pyelonephritis replacing the left kidney (arrow).

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Figure 2: (A-D) Intraoperative images during bilateral nephrectomy showing dense adhesions around the kidney and thrombus visualized in the renal artery (arrow).

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Figure 3: (A-D) Haematoxylin- and eosin-stained sections of kidney specimen showing the arterial wall with fibrin thrombi and multiple broad aseptate foldable hyphae with lack of inflammatory cells and infarction of renal parenchyma (arrow).

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Acknowledgment: Authors acknowledge Dr Ujjwal Gorsi, department of Radiology, PGIMER, Chandigarh, for providing high-quality radiology images.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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