Incidental isolated renal mucormycosis in immunocompetent patient: a rare and atypical presentation

ABSTRACT

Mucormycosis is a group of clinical syndromes resulting from infection by one of a group of related filamentous fungi. It is an opportunistic fungal infection that rarely occurs in immunocompetent individual. Isolated involvement of any organ is rare and only a few cases of renal mucormycosis have been reported. We present a case report of atypical presentation of a case of renal mucormycosis in a healthy adult with no predisposing factors. A 48 year non diabetic immunocompetent patient underwent right nephrectomy for painful non-functioning kidney. Biopsy showed chronic pyelonephritis with broad non-septate hyphae suggestive of mucormycosis. Post op followup of patient is normal. Mucormycosis of kidney causes extensive infarction and necrosis due to direct angioinvasion and vascular thrombosis leading to fulminant acute renal failure. The disease mimics pyogenic infection leading to delay in diagnosis and hence resulting in high mortality. High index of suspicion is needed for early diagnosis. Urine and blood cultures are usually sterile. Characteristic CT findings include diffuse enlargement of the kidney with absence of contrast excretion and multiple low-density areas in the renal parenchyma representing fungal abscess. Whenever suspected, FNAC or biopsy is strongly advocated as no imaging can confirm the diagnosis. Nephrectomy or debridement of necrotic tissue along with IV Amphotericin B consist the principal treatment. Renal mucormycosis presenting an indolent course and found incidentally after nephrectomy is extremely rare. In an incidentally found mucormycosis, the role of further investigations to find the source and the role of antifungals have to be further studied.