Isolated Renal Mucormycosis in a Healthy Immunocompetent Patient: Atypical Presentation and Course

Isolated renal mucormycosis is rarely identified and has been described in only a handful of cases. We hereby report a case of isolated renal mucormycosis with an atypical presentation in an immunocompetent patient with no identifiable risk factors. A 30-year-old nondiabetic male presented with a poorly functioning right kidney with minimal constitutional symptoms. The patient underwent a right simple nephrectomy. Histopathology revealed necrotizing xanthogranulomatous pyelonephritis with mucormycosis. The postoperative period was uneventful and the patient was managed without any antifungal administration. We hereby emphasize that renal mucormycosis can affect immunocompetent healthy adults without any previously known risk factors and that asymptomatic patients with no evidence of fungemia or disseminated disease can be managed without administration of intravenous amphotericin.

Clinical predictors of fulminant colitis in patients with clostridium difficile infection

Clostridium difficile infection [CDI] can affect up to 8% of hospitalized patients. Twenty-five percent CDI patients may develop C. difficile associated diarrhea [CDAD] and 1-3% may progress to fulminant C. difficile colitis [FCDC]. Once developed, FCDC has higher rates of complications and mortality. A 10-year retrospective review of FCDC patients who underwent colectomy was performed and compared with randomly selected age- and sex-matched non-fulminant CDAD patients at our institution. FCDC [n=18] and CDAD [m=49] groups were defined clinically, radiologically, and pathologically. Univariate analysis was performed using Chi-square and Student's t test followed by multivariate logistic regression to compute independent predictors. FCDC patients were significantly older [77 +/- 13 years], presented with triad of abdominal pain [89%], diarrhea [72%], and distention [39%]; 28% had prior CDI and had greater hemodynamic instability. In contrast, CDAD patients were comparatively younger [65 +/- 20 years], presented with only 1 or 2 of these 3 symptoms and only 5% had prior CDI. No significant difference was noted between the 2 groups in terms of comorbid conditions, use of antibiotics, or proton pump inhibitor. Leukocytosis was significantly higher in FCDC patients [18.6 +/- 15.8/mm[3]us 10.7 +/- 5.2/mm[3], P=0.04] and further increased until the point of surgery. Use of antiperistaltic medications was higher in FCDC than CDAD group [56% vs 22%; P=0.01]. Our data suggest several clinical and laboratory features in CDI patients, which may be indicative of FCDC. These include old age [>70 years], prior CDI, clinical triad of increasing abdominal pain, distention and diarrhea, profound leukocytosis [>18,000/mm[3]], hemodynamic instability, and use of antiperistaltic medications