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Case Reports: Learning from unexpected outcome (positive or negative)
Biopsy-proven fungal pyelonephritis complicating delayed graft function in a renal transplant patient
  1. Aaron Jesuthasan1,
  2. Candice Roufosse2,3 and
  3. Arun Ramaswami1
  1. 1Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Immunology and Inflammation, Imperial College London, London, UK
  3. 3Cellular Pathology, North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Aaron Jesuthasan; aaronjesuthasan{at}gmail.com

Abstract

Delayed graft function (DGF) is a common phenomenon following renal transplantation, which can be due to several factors. A rare cause includes invasive fungal infections, which can often be a challenge to diagnose. Nonetheless, prompt identification of such infections particularly within transplant patients is essential as they can lead to severe downstream sequelae, including graft loss and even death. We describe here a challenging case of fungal pyelonephritis complicating and potentially leading to DGF and further dialysis dependence within a renal transplant patient. Notably, we highlight the importance and clinical utility of biopsy to confirm the diagnosis, as investigations may be largely normal otherwise. Furthermore, we emphasise that with early identification of these infections, effective antifungal treatment can be commenced in a timely fashion leading to better patient outcomes and good graft function.

  • Renal transplantation
  • Renal intervention
  • Urinary tract infections

http://dx.doi.org/10.1136/bcr-2022-252313

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    Footnotes

    • Contributors AJ led the writing of the manuscript and, together with AR, was part of the treating team for the patient. CR was the acting histopathologist, integral toward the diagnosis of fungal pyelonephritis. AR and CR critically evaluated the manuscript and all authors approved the final submitted version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.