Renal abscess due to Aspergillus fumigatus as the only sign of disseminated aspergillosis in a patient with AIDS

Antecedentes. Aspergillus fumigatus puede provocar un amplio espectro de síndromes clínicos en diversos grupos de pacientes inmunodeficientes, como los infectados por el VIH. La aspergilosis renal primaria es una entidad extremadamente rara. Objetivo. Comunicar un caso infrecuente de absceso renal por Aspergillus fumigatus en un paciente con SIDA. Métodos. Revisión de ficha clínica y seguimiento del paciente. Resultados. Se presenta el caso de un paciente de 38 años, VIH positivo, quien ingresa en el hospital por presentar fiebre, lumbalgia izquierda y síntomas respiratorios. Los estudios de imagen revelaron la existencia de una gran lesión en el riñón izquierdo compatible con un absceso. La biopsia por aspiración dirigida por ecografía logró la obtención de una muestra clínica que permitió el aislamiento de Aspergillus fumigatus. A pesar del tratamiento con anfotericina B desoxicolato y el drenaje del absceso, el cuadro no mostró mejoría por lo cual se realizó la nefrectomía. El examen histopatológico de la pieza quirúrgica confirmó el diagnóstico de aspergilosis renal. Tras la exéresis se instauró tratamiento con voriconazol por vía intravenosa y oral en forma secuencial, asociado al tratamiento antirretroviral de gran actividad. El paciente mostró una buena respuesta al esquema terapéutico y continuaba en buena condición clínica un año después de su egreso hospitalario. Conclusiones. La aspergilosis debe incluirse en el diagnóstico diferencial del compromiso renal en pacientes con sida. En el caso que se presenta, el inicio precoz del tratamiento con AMB y luego voriconazol seguido por la nefrectomía permitió la recuperación del paciente con estabilización del cuadro durante el período de seguimiento(AU)

Background. Aspergillus fumigatus can cause a wide variety of clinical syndromes, especially in the three largest immunocompromised groups, such as HIV-infected patients. Primary renal aspergillosis is an extremely rare entity. Aims. We report an unusual case of renal abscess due to Aspergillus fumigatus in a patient with AIDS. Methods. We review clinical and laboratory records, and provide follow up of the patient. Results. A 38-year-old man, HIV seropositive, was admitted to our hospital with fever, lumbar pain and respiratory symptoms. Abdominal ultrasound and computerised tomography showed a single and large lesion consistent with an abscess located in the left kidney. Aspergillus fumigatus was isolated from clinical sample obtained by ultrasound-guided needle aspiration. Despite a correct treatment based on amphotericin B and drainage of the abscess, surgery was necessary and nephrectomy was carried out. Histopathological examination of the surgical specimen confirmed the diagnosis of renal aspergillosis. Systemic antifungal therapy based on intravenous and oral voriconazole and highly active antiretroviral therapy was started after surgery. The patient had a good response to the established treatment and he remains in a good clinical condition at one year of follow up. Conclusions. Combined medical and surgical treatment is the elective therapy for renal abscesses due to Aspergillus when percutaneous drainage and the administration of systemic antifungal drugs, such as amphotericin B and/or oral voriconazole or itraconazole, fail. This case emphasizes renal fungal infections should be included in the differential diagnosis of kidney abscesses in AIDS patients(AU)

Renal abscess due to Aspergillus fumigatus as the only sign of disseminated aspergillosis in a patient with AIDS.

BACKGROUND: Aspergillus fumigatus can cause a wide variety of clinical syndromes, especially in the three largest immunocompromised groups, such as HIV-infected patients. Primary renal aspergillosis is an extremely rare entity. AIMS: We report an unusual case of renal abscess due to Aspergillus fumigatus in a patient with AIDS. METHODS: We review clinical and laboratory records, and provide follow up of the patient. RESULTS: A 38-year-old man, HIV seropositive, was admitted to our hospital with fever, lumbar pain and respiratory symptoms. Abdominal ultrasound and computerised tomography showed a single and large lesion consistent with an abscess located in the left kidney. Aspergillus fumigatus was isolated from clinical sample obtained by ultrasound-guided needle aspiration. Despite a correct treatment based on amphotericin B and drainage of the abscess, surgery was necessary and nephrectomy was carried out. Histopathological examination of the surgical specimen confirmed the diagnosis of renal aspergillosis. Systemic antifungal therapy based on intravenous and oral voriconazole and highly active antiretroviral therapy was started after surgery. The patient had a good response to the established treatment and he remains in a good clinical condition at one year of follow up. CONCLUSIONS: Combined medical and surgical treatment is the elective therapy for renal abscesses due to Aspergillus when percutaneous drainage and the administration of systemic antifungal drugs, such as amphotericin B and/or oral voriconazole or itraconazole, fail. This case emphasizes renal fungal infections should be included in the differential diagnosis of kidney abscesses in AIDS patients.