Invasive Urinary Tract Aspergillosis: A Rare Entity

We report a rare case of severe acute kidney injury (AKI) due to invasive urinary aspergillosis in a 59-year-old male. Our patient underwent extracorporeal shock wave lithotripsy (ESWL) for bilateral renal calculi followed by bilateral ureteral stent placement. Initially, urine bacteriological cultures were sterile, and renal function was normal. Days later, he developed rapidly progressive oligo-anuric AKI requiring hemodialysis. Despite stent replacement and empirical antibiotics, infection markers continued to rise, and the newly replaced stents became obstructed for the second time. Ureteroscopy-guided urine culture identified <i>Aspergillus fumigatus</i>. A few days after the initiation of voriconazole therapy, the patient demonstrated significant clinical and biological improvement, including urine clarification and normalization of renal function. This case highlights the need to consider fungal infections in persistent unexplained obstructive AKI and underscores the importance of early diagnosis and antifungal therapy.