Urinary Tract Aspergillosis in a Child with Pelviureteric Junction Obstruction

Abstract

Aspergillus spp. are fungi which are mostly nonpathogenic, but some species such as Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger can cause aspergillosis in humans. Aspergillosis can manifest as pulmonary or extrapulmonary infections, with respiratory involvement being common but infections in other body parts being rare. Urinary aspergillosis, an uncommon manifestation of Aspergillus infection, presents unique challenges in diagnosis and management due to its rarity and varied clinical presentations. It is seen in immunocompromised individuals, patients with underlying structural urinary tract abnormalities, or those undergoing invasive procedures. Here, we present a case of an 8-month-old child who presented with intermittent fever and increased urination since birth. The child underwent bilateral open pyeloplasty with double-J (DJ) stenting. A month later, the child returned with anuria, fever, and abdominal mass, leading to infected DJ stent removal and bilateral percutaneous nephrostomy. Despite antibiotic treatment, fever persisted. A fungal culture was done which showed growth of A. flavus. Liposomal amphotericin B was started for the patient after which he became afebrile, and all the fungal cultures done, thereafter, were negative. Urinary tract aspergillosis is rare, particularly among individuals with a strong immune system. Persistence of urinary tract symptoms despite antibiotic and medical therapy may raise the possibility of fungal infection such as urinary tract aspergillosis.