Renal Candidosis Complicating Caeco-Cystoplasty: Case Report with Scanning Electron Microscopic Studies

Abstract

Asymptomatic funguria caused by yeast-like fungi is usually harmless. However, if the patient's general condition deteriorates it may give rise to manifest fungous infection. The funguria which usually occurs postoperatively in patients with caeco-cystoplasty or ileal conduit behaves like other asymptomatic funguria. If the condition of a patient who has undergone such surgery deteriorates due to, for example, postoperative complications, it is important that the risk of manifest fungms infection is not overlooked. A 49-year-old woman in whom caeco-cystoplasty was performed because of interstitial cystitis developed suture insufficiency in the ileo-colo-anastomosis and was reoperated upon. After an initial period of improvement the patient died due to anuria of unknown cause. At autopsy the renal pelves were found to be filled with fungous bezoars and fungus—on cultivation proved to be Candida alhicans—had infiltrated the renal papillae. Investigation by scanning electron microscopy showed that the collecting tubules in the renal papillae were completely filled with fungi, which were present mainly in the so-called yeast form. It has been discussed whether this morphologic variant of Candida albicans is pathogenic. It is clear that it can at least produce serious complications by causing mechanical obstruction.