ESPN 51th Annual Meeting

ESPN 2018


 
MYCETOMA OF THE URINARY TRACT IN AN INFANT WITH HORSESHOE KIDNEY: USEFULNESS OF MECHANICAL REMOVAL AND AMPHOTERICIN-B IRRIGATION
BERNA OGUZ 1 KUBRA CELEGEN 2 ARBAY OZDEN CIFTCI 3 EMRE UNAL 1 MEHMET EMIN SENOCAK 3 OZLEM OZKALE YAVUZ 1 NESRIN TAS 2 BORA GULHAN 2 FATIH OZALTIN 2 REZAN TOPALOGLU 2 ALÄ° DUZOVA 2

1- DEPARTMENT OF RADIOLOGY, HACETTEPE UNIVERSITY FACULTY OF MEDICINE, ANKARA
2- DIVISION OF PEDIATRIC NEPHROLOGY, HACETTEPE UNIVERSITY FACULTY OF MEDICINE, ANKARA
3- DEPARTMENT OF PEDIATRIC SURGERY, HACETTEPE UNIVERSITY FACULTY OF MEDICINE, ANKARA
 
Introduction:

Obstruction of urinary tract secondary to mycetoma or fungus bezoars (balls) is extremely rare. We report a case of a nine-month-old girl, with no immunodeficiency, who suffered from mycetoma and successfully treated with mechanical removal combined with intravenous and irrigation therapy.

Material and methods:

The patient was the first child of non-consanguineous parents. Horseshoe kidney and probable ureteropelvic junction (UPJ) obstruction was detected during antenatal period. After the delivery the evaluation supported UPJ obstruction. Pyeloplasty was performed for left UPJ obstruction on 45th day; and the patient was discharged with antibiotic prophylaxis. At 8 months of age, the patients had two episodes of UTI which were treated with IV and oral antibiotics. Two weeks after discharge she was admitted with fever, vomiting, poor weight gain and dehydration

Results:

Laboratory examination was compatible with UTI. Candida albicans was isolated from urine culture. A renal ultrasound showed nonshadowing echogenic mass with no vascularity compatible with mycetoma (fungus ball) in the dilated right renal pelvis. Intravenous amphotericin-B was instituted. A right nephrostomy tube was inserted due to persistent and slightly enlarging hydronephrosis and mycetoma invading into renal calyces on serial ultrasound. Hydronephrosis at UP level disappeared; nevertheless, a new mycetoma was detected in right distal ureter and UV junction despite IV amphotericin B. Daily direct irrigation with amphotericin-B was also instituted. Antegrade pyelography through nephrostomy confirmed the presence of a distal ureteral obstruction. Hence, with antegrade access through nephrostomy mechanical shredding and removal of mycetoma was held successfully. Nephrostomy tube was removed after 3 weeks of amphotericin-B irrigation accompanied with IV treatment.

Conclusions:

Underlying renal anomaly, recurrent UTI, hospitalization and systemic antibiotic use might have resulted in the development of a severe case of mycetoma of the urinary tract. Mechanical removal combined with intravenous and irrigation therapy may be necessary in challenging conditions.