Isolated Renal Mucormycosis in Immunocompetent Hosts: Clinical Spectrum and Management Approach

Sudheer K. Devana Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Vijayanth G. Gupta Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Ravimohan S. Mavuduru Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Girdhar S. Bora Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Aditya P. Sharma Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Kalpesh M. Parmar Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Santosh Kumar Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Uttam K. Mete Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Shrawan K. Singh Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Arup K. Mandal Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Nandita Kakkar Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Nirmalya Banerjee Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

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Anup Ghosh Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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DOI:
https://doi.org/10.4269/ajtmh.18-0103
Volume/Issue:
Volume 100: Issue 4
Page(s):
791–797
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Isolated renal mucormycosis in immunocompetent hosts is a rare entity. We present the largest case series of isolated renal mucormycosis in immunocompetent hosts. Retrospective data of isolated renal mucormycosis from March 2012 to June 2017 was reviewed. Fifteen patients of isolated renal mucormycosis were identified. Contrast-enhanced computed tomography scan showed enlarged globular kidneys with decreased or patchy enhancement, perinephric stranding and thickened Gerota’s fascia in all patients. Ten patients with unilateral involvement underwent nephrectomy and two of four patients with bilateral renal mucormycosis underwent bilateral nephrectomy. Two patients were managed with intravenous antifungal therapy alone. Overall, the mortality rate in our series was 40% (6/15). Isolated renal mucormycosis in healthy immunocompetent hosts is an emerging new entity. Prompt diagnosis based on the characteristic clinical and radiological picture and starting high-dose antifungal therapy at least 24 hours before surgical debridement offer the best chance of survival in these patients.

Author Notes

Address correspondence to Sudheer K. Devana, Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail: drsudheer1983@gmail.com

Authors’ addresses: Sudheer K. Devana, Vijayanth G. Gupta, Ravimohan S. Mavuduru, Girdhar S. Bora, Aditya P. Sharma, Kalpesh M. Parmar, Santosh Kumar, Uttam K. Mete, Shrawan K. Singh, and Arup K. Mandal, Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, E-mails: drsudheer1983@gmail.com, vijayantgovinda@gmail.com, ravismi2003@yahoo.com, girdhar2k@gmail.com, aditya.p.sharma@gmail.com, kalpesh010385@gmail.com, santoshsp1967jaimatadi@yahoo.co.in, uttammetepgi@gmail.com, shrawanksingh2002@yahoo.com, and drarupkumar@gmail.com. Nandita Kakkar and Nirmalya Banerjee, Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, E-mails: nandita_kakkar@yahoo.com and nirmalyapgi@gmail.com. Anup Ghosh, Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, E-mail: anupkg3@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2019
Received:
03 Feb 2018
|
Accepted:
06 Dec 2018
|
Published Online:
14 Jan 2019
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Singh AK, Goel MM, Gupta C, Kumar S, 2014. Isolated renal zygomycosis in an immunocompetent patient. BMJ Case Reports 2014: bcr2013200060.

  • 2.

    Dhaliwal HS et al. 2015.Diagnosed only if considered: isolated renal mucormycosis. Lancet 385: 2322.

  • 3.

    Pickles R, Long G, Murugasu R, 1994. Isolated renal mucormycosis. Med Journal Aust 160: 514–516.

  • 4.

    Rogenes V, Vick S, Pultizer DR, 1998. Isolated renal mucormycosis. Infect Urol 113: 78–83.

  • 5.

    Gupta KL, Joshi K, Kohli HS, Jha V, Sakhuja V, 2012. Mucormycosis (zygomycosis) of renal allograft. Nephrol Dial Transplant Plus 5: 502–507.

  • 6.

    Pahwa M, Pahwa AR, Girotra M, Chawla A, 2013. Isolated renal mucormycosis in a healthy immunocompetent patient: atypical presentation and course. Korean J Urol 54: 641–643.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Chakrabarti A, Das A, Sharma A, Panda N, Das S, Gupta KL, Sakhuja V, 2001. Ten years experience in zygomycosis at a tertiary care centre in India. J Infect 42: 261–266.

  • 8.

    Gupta KL, Radotra BD, Sakhuja V, Banerjee AK, Chugh KS, 1989. Mucormycosis in patients with renal failure. Ren Fail 11: 195–199.

  • 9.

    Chakrabarti A, Dhaliwal M, 2013. Epidemiology of mucormycosis in India. Curr Fungal Infect Rep 7: 287–292.

  • 10.

    Mignogna MD, Fortuna G, Leuci S, Adamo D, Ruoppo E, Siano M, Mariani U, 2011. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 15: e533–e540.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Gupta KL, Joshi K, Sud K, Kohli HS, Jha V, Radotra BD, Sakhuja V, 1999. Renal zygomycosis: an under-diagnosed cause of acute renal failure. Nephrol Dial Transplant 14: 2720–2725.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Chugh KS, Sakhuja V, Gupta KL, Jha V, Chakravarty A, Malik N, Kathuria P, Pahwa N, Kalra OP, 1993. Renal mucormycosis: computerized tomographic findings and their diagnostic significance. Am J Kidney Dis 22: 393–397.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Paonam S, Bag S, Mavuduru RS, Agarwal MM, Mandal AK, 2014. Isolated bilateral renal mucormycosis masquerading as renal abscess in an immunocompetent individual: a lesson learnt. Case Rep Urol 2014: 304380.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Cornely OA et al. European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group; European Confederation of Medical Mycology, 2014. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 20: 5–26.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Devana SK, Bora GS, Mavuduru RS, Panwar P, Kakkar N, Mandal AK, 2016. Successful management of renal mucormycosis with antifungal therapy and drainage. Indian J Urol 32: 154–155.

    • PubMed
    • Search Google Scholar
    • Export Citation
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