Isolated Renal Mucormycosis in a Healthy Immunocompetent Patient: Atypical Presentation and Course
A 30-year-old normotensive nondiabetic male presented with complaints of right flank pain on and off for the past 1 year. The pain had started as a sudden severe aching pain that was initially associated with painless hematuria, low-grade fever, and nausea. The patient was admitted to the hospital and was managed on parenteral antibiotics. His symptoms subsided on this conservative treatment, but he continued to have similar recurrent episodes over the past 1 year. He had no history of decreased appetite or weight loss. On evaluation, the patient was found to have a total leukocyte count of 9,700 cells/mm3 and serum creatinine of 0.88 mg/dL. Urine examination was unremarkable. Contrast enhanced computed tomography revealed a right upper polar heterogeneous nonenhancing mass about 8 cm×10 cm in size (). The right kidney was found to have a glomerular filtration rate of 7.4 mL/min on a technetium 99m-diethylene triamine pentaacetic acid scan. The patient underwent a right nephrectomy, and histopathology of the resected specimen revealed necrotizing granulomatous inflammation associated with mucormycosis and xanthogranulomatous pyelonephritis (). Inflammatory cells consisted of foamy histiocytes, few multinucleate giant cells, plasma cells, and lymphocytes. Large areas of necrosis were present along with palisading epithelioid cells and epithelioid cell granulomas at the periphery. Fungal elements were described as broad, aseptate fungi with right angled branching hyphae (). The patient had an uneventful postoperative course and recovery. Because the patient showed no signs of sepsis preoperatively or postoperatively, no antifungals were given and the patient was managed conservatively on that front.