Korean J Hematol.  2010 Dec;45(4):275-278. 10.5045/kjh.2010.45.4.275.

Primary renal aspergillosis and renal stones in both kidneys associated with hematopoietic stem cell transplant

• Park H
• Lee MJ
• Kim Y
• Min YH
• Kim SJ
• Kim D

• KMID: 2252041
• DOI: http://doi.org/10.5045/kjh.2010.45.4.275

Abstract

Invasive aspergillosis (IA) is a leading cause of infectious mortality in patients who have undergone a hematopoietic stem cell transplant (HSCT); the mortality due to IA ranges from 70% to 93% in HSCT patients. Early diagnosis and treatment are the cornerstones for the good prognosis of IA. Primary renal aspergillosis is an extremely rare presentation in patients who have undergone HSCT, and the risk factor for this uncommon presentation is not well known. We report a patient who developed primary renal aspergillosis and renal stones in both the kidneys after HSCT. Invasive renal aspergillosis was diagnosed after a nephrectomy, which was performed to treat massive renal hematoma.

Keyword

Primary renal aspergillosis; Hematopoietic stem cell transplant; Renal stones

MeSH Terms

Aspergillosis
Early Diagnosis
Hematoma
Hematopoietic Stem Cells
Humans
Kidney
Nephrectomy
Prognosis
Risk Factors
Transplants

Figure

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  Fig. 1 Multiple renal and ureteral stones (arrow) with hydronephrosis.

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  Fig. 2 Images of the renal parenchymal tearing with active bleeding, subcapsular hematoma in the right kidney (left panel), and prostate abscess (right panel).

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  Fig. 3 Right kidney with perirenal hematoma after radical nephrectomy.

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  Fig. 4 Renal biopsy showing renal parenchymal and vascular invasion by Aspergillus hyphae (left panel, Periodic Acid Schiff (PAS) stain, ×100; right panel, PAS stain, ×200).

Reference

1. Kwon O, Woo JG, Yi JE, Jung GW, Cho S, Kim SR. A case of invasive aspergillosis limited to renal allograft. Korean J Nephrol. 2010; 29:300–304.

2. Na HH, Hong SW, Kim MC, Kang YK, Yoon YC, Koh HI. A case of invasive aspergillosis in transplanted kidney and perirenal area. J Korean Soc Transplant. 2008; 22:135–137.

3. Chung WB, Lee DG, Choi YK, et al. A case of isolated renal aspergillosis in a patient with acute myelocytic leukemia. Korean J Med. 2004; 67(Suppl 3):S845–S849.

4. Watts JC, Chandler FW. Connor DH, Chandler FW, Schwartz DA, editors. Aspergillosis. Pathology of infectious diseases. 1997. Vol. 2. Stamford, USA: Appleton & Lange;p. 933–941.

5. Upton A, Kirby KA, Carpenter P, Boeckh M, Marr KA. Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality. Clin Infect Dis. 2007; 44:531–540. PMID: 17243056.

6. Chandrasekar PH, Ramesh M. Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation. Expert Rev Anti Infect Ther. 2009; 7:1151–1153. PMID: 19968505.

7. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008; 46:1813–1821. PMID: 18462102.

8. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006; 42:1417–1427. PMID: 16619154.

9. Wheat LJ. Approach to the diagnosis of invasive aspergillosis and candidiasis. Clin Chest Med. 2009; 30:367–377. PMID: 19375641.

10. Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002; 347:408–415. PMID: 12167683.

11. Herbrecht R, Maertens J, Baila L, et al. Caspofungin first-line therapy for invasive aspergillosis in allogeneic hematopoietic stem cell transplant patients: an European Organisation for Research and Treatment of Cancer study. Bone Marrow Transplant. 2010; 45:1227–1233. PMID: 20062093.

12. de Medeiros CR, Dantas da Cunha A Jr, Pasquini R, Arns da Cunha C. Primary renal aspergillosis: extremely uncommon presentation in patients treated with bone marrow transplantation. Bone Marrow Transplant. 1999; 24:113–114. PMID: 10435746.

13. Haq JA, Khan MA, Afroze N, Haq T. Localized primary renal aspergillosis in a diabetic patient following lithotripsy-a case report. BMC Infect Dis. 2007; 7:58. PMID: 17567923.

14. Godec CJ, Mielnick A, Hilfer J. Primary renal aspergillosis. Urology. 1989; 34:152–154. PMID: 2675456.

15. Eisenberg RL, Hedgcock MW, Shanser JD. Aspergillus mycetoma of the renal pelvis associated with ureteropelvic junction obstruction. J Urol. 1977; 118:466–467. PMID: 904060.