Multi-route antifungal administration in the management of urinary Candida glabrata bezoar

A case of ureteral fungal mass removal in a patient taking empagliflozin

“…Treatment of fungal bezoars can be difficult and typically require medical and surgical intervention, including systemic antifungal treatment, antegrade antifungal irrigations through nephrostomy tracts, or even surgical removal via a percutaneous or ureteroscopic approach [6]. Percutaneous access through a PCN tube allows the surgeon to easily debulk or remove proximal fungal infections [7]. In our case, because of the degree of ureteral dilation from the obstructing fungal ball, a ureteroscopic approach with a large ureteral access sheath was attempted (Fig.…”

“…Therefore, The Infectious Disease Society of America currently recommends antegrade irrigation of nephrostomy tubes using amphotericin B as treatment for fungal bezoars (strong recommendation, low level of evidence), but a recommended treatment length is not given [8]. Different case reports have utilized treatment from 5-6 days of irrigation and 14-19 days of IV antifungal therapy [7]. Amphotericin B is nephrotoxic through direct damage to the proximal tubules (systemic or irrigation), therefore, antegrade irrigations in the setting of negative fungal cultures could have led to unnecessary renal injury in our patient [9].…”

A Case of Obstructing Candida Glabrata Bladder Mucus Treated with Intravesicular Amphotericin - B

“…Instead, bladder irrigation with amphotericin B Deoxycholate for 5 days is suggested [6] . The combination of multi-route antifungal therapy (amphotericin and flucytosine) and decompression of the collecting system was successful and avoided the need for surgical source control of the C. glabrata bezoars [10][11][12] .…”