Abscesos renales bilaterales multifocales por Candida albicans / Bilateral multifocal kidney abscess due to Candida al bicans

Resumen Los abscesos renales son una complicación poco frecuente de las infecciones del tracto urinario y suelen asociarse con un aumento de la morbi-mortalidad. La mayoría de los casos ocurre en pacientes con factores predisponentes como la inmunosupresión. El diagnóstico requiere de una elevada sospecha clínica y el trata miento consiste en el uso de antibióticos y antifúngicos parenterales asociados o no a intervenciones quirúrgicas como nefrostomía y nefrectomía. Son pocos los casos publicados en la literatura médi ca de abscesos renales bilaterales multifocales y menos aún por Candida albicans. Se presenta el caso de una mujer de 20 años de edad con diabetes mellitus tipo 1 diagnosticada a los 8 años, múltiples internaciones por cetoacidosis diabética y reciente internación por can didemia (Candida albicans) completando tratamiento con fluconazol por 23 días. A los 18 días de su externación, consulta por dolor en flancos de tipo sordo y síntomas ge nerales; se realizó tomografía de abdomen con contraste que mostró abscesos multifocales bilaterales. Aislándose Candida albicans en una de las muestras obtenidas de las lesiones; recibió tratamiento con fluconazol 400 mg por 6 semanas endovenoso y 2 semanas vía enteral, evolu cionando favorablemente con mejoría clínica e image nológica continuando seguimiento clínico ambulatorio. Este reporte resalta la importancia del diagnóstico y tratamiento de esta complicación infrecuente en enfer medades complejas como la diabetes.

Abstract Renal abscesses are a rare complication of urinary tract infections and may be associated with increased morbidity and mortality. Most cases occur in patients with predisposing factors such as immunosuppression. Diagnosis requires high clinical suspicion and its treat ment consists in the use of parenteral antibiotics and antifungals associated or not with surgical interventions such as nephrostomy and nephrectomy. Few cases have been published in the medical literature of multifocal bilateral renal abscesses and even fewer due to Candida albicans. We present the case of a 20-year-old woman with type 1 diabetes mellitus, diagnosed at age 8, multiple hospitalizations for diabetic ketoacidosis, and recent hospitalization for candidemia (Candida albicans) treated with fluconazole for 23 days. Eighteen days after her discharge, she consulted for dull flank pain and gen eral symptoms. Contrast enhanced abdominal tomography showed bilateral multifocal abscesses and Candida albicans was isolated in one of the samples obtained from lesions. She received fluconazole 400 mg, 6 weeks i.v. and 2 weeks via enteral route, evolving favorably with clinical and imag ing improvement, continuing outpatient clinical monitoring. This report highlights the importance of diagnosis and treatment of this rare complication in complex diseases such as diabetes mellitus.

CT Findings of Acute Pyelonephritis and Clinical Correlation

PURPOSE: To evaluate postcontrast CT findings of acute pyelonephritis and correlate these with clinical findings and severities. MATERIALS AND METHODS: We retrospectively reviewed the medical records and CT scans of 50 patients with abnormal CT findings among 52 patients of acute pyelonephritis whose postcontrast CT scans had been examined. Fifty cases of acute pyelonephritis were classified into three subgroups on the basis of postcontrast CT findings : Group I (n=20, 40%) wedge-shaped lesions; Group II (n=13, 26%) mass-like lesions; Group III (n=17, 34%) renal abscess formation. In each group, clinical findings and severity were analyzed and correlated with CT findings. The results were statistically analyzed. RESULTS: Although mean values of clinical parameters of group I were lower than those of group II and III with regard to all clinical parameters (including maximal temperature and duration of fever, flank pain, leukocytosis, and admission period), there was no statistically significant correlation among the three groups (p>0.05). All cases were successfully treated with antibiotics only, despite the high rate of abscess formation (34%). CONCLUSION: Acute pyelonephritis spans a continuum of CT findings of varying severity from wedge-shaped or mass-like lesions to multifocal abscesses ; postenhanced CT scan shows high sensitivity (96%) in the detection of acute pyelonephritis. Although the clinical course of groups of mass-like lesions and abscess formation was longer and more severe than that of wedge-shaped lesions, there was no statistically significant clinicoradiologic correlation among the three groups.

CT Findings of Renal Abscess

PURPOSE: The purpose of this study is to determine characteristic CT findings in renal abscess. MATERIAL AND METHODS: Twenty cases of renal abscess were retrospectively analyzed for CT findings relating to the shape andextent of the abscess, change of nephrogram, peripheral rim enhancment, wedge-shaped enhancement on delayed scans, enlargement of the kidney involved and associated findings. RESULTS: Seven patients had a renal abscess at the right kidney, nine at the left kidney and two bilaterally. The abscesses were round in 18 cases and finger-like in two. Rim enhancement around renal abscess was seen in four cases(20%). Changes in the nephrogram around the abscess were seen in 12 cases(60%). In all six patients who had undergone delayed postcontrast scans, wedge-shaped enhancement was shown around the abscess(100%). In the observation of the extent of renal abscesses, 14 cases were within the kidney, six cases extended the beyond renal capsule, and two were loculated in the renal fascia itself. Renal enlargement was seen in nine cases(45%). CONCLUSION: These results suggest that CT findings such as delayed wedge-shaped enhancement, change of nephrogram, peripheral rim enhancement, renal enlargement, and associated findings are valuable for diagnosis, and that CT also gives information concerning the extent, evolution and complication of a renal abscess.