Unilateral renal phaeohyphomycosis due to Bipolaris spicifera in an immunocompetent child – rare case presentation and review of literature

Abstract

Phaeohyphomycosis refers to infections caused by phaeoid fungi that can have an aggressive course in normal hosts. We report a case of left-sided renal phaeohyphomycosis due to Bipolaris spicifera in a 7-year-old immunocompetent male child. He presented with fever, dysuria, nausea, vomiting and flank pain. Examination revealed tenderness at the left costovertebral angle. Histological examination and culture of biopsy from left kidney and blood yielded the fungal pathogen Bipolaris spicifera. His past history revealed that he was diagnosed perinatally with bilateral hydronephrosis due to bilateral pelvic ureteric junction obstruction. He underwent an open dismembered pyeloplasty on the left side followed by the right side pyeloplasty at the age of 6 months and 1.5 years respectively. He was on a regular follow-up for 5 years and had been doing well. Now he was diagnosed as a case of unilateral renal phaeohyphomycosis. The patient was managed successfully with antifungal drugs amphotericin B and itraconazole. A review of previously reported bipolaris cases with their clinical manifestations, treatment and outcome is presented. Renal phaeohyphomycosis remains an unusual disease. Aggressive diagnostic approaches and careful management helped in survival of the patient.

Feohifomicosis nasal por Curvularia spicifera en un paciente pediátrico con neutropenia y leucemia mieloide aguda

“…El manejo inicial de las lesiones cutáneas involucra el desbridamiento quirúrgico agresivo con márgenes libres. En general, las feohifomicosis localmente invasoras tienden a responder a un amplio rango de agentes antifúngicos 1,32,35 . Las infecciones diseminadas pueden ser fatales, por lo que es imperativo el diagnóstico precoz y definir su extensión para el rápido inicio de la terapia 25,26 .…”

“…Las infecciones diseminadas pueden ser fatales, por lo que es imperativo el diagnóstico precoz y definir su extensión para el rápido inicio de la terapia 25,26 . En estos casos, el tratamiento se basa en la terapia antifúngica sistémica, tradicionalmente con anfotericina B, en algunos casos en conjunto con azoles 25,35 . Tratamientos con itraconazol han mostrado resultados positivos 33 .…”