Rare Case of Aspergillus fumigatus Isolated from Renal Stone in an Immunocompetent Patient

Rajshree Bhujel,1,* Niraj Thapa,2 Rajani Shrestha,1 Prashant Pandit,1 Ashmita Sapkota,1 Kamana Chhetri,1 Sampada Subba,1 Bhudev Singh Rajput,3 Shishir Gokhale,1 Niranjan Nayak1,* 1Department of Microbiology, Manipal Teaching Hospital, Pokhara, Nepal; 2Department of Urology, Manipal Teaching Hospital, Pokhara, Nepal; 3School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal*These authors contributed equally to this workCorrespondence: Rajshree Bhujel, Department of Microbiology, Manipal Teaching Hospital, Pokhara, Gandaki, Nepal, Email [email protected]: Aspergillus species are relatively rare and typically occur in immune compromised individuals such as those undergoing organ transplantation, chemotherapy, or long-term corticosteroid therapy. Renal Aspergillosis is an uncommon manifestation that generally occurs as part of a disseminated infection in immunocompromised patients.Case: A 22 yrs male patient came to emergency department of Manipal Teaching Hospital with the chief complaints of right flank pain, 3– 4 episodes of vomiting for last 4 days, had acute onset, gradually progressive non-radiating aggravated pain and no history of any other medical conditions. His urine sample showed plenty of red blood cell in routine microscopy and other blood laboratory tests were within normal limit. Computed tomography of the kidneys, ureter and bladder showed multiple bilateral stones in both kidneys. Kidney stones were surgically removed by bilateral retrograde intrarenal surgery with total lithotripsy. After surgery, the renal calculi were received in microbiology laboratory for microbial analysis. The crushed material of renal stone was used for microbial culture and direct microscopy using 10% KOH wet mount which showed hyphae. Both bacterial culture media and Sabouraud’s Dextrose Agar showed growth of molds which was identified as Aspergillus fumigatius. The patient was treated with voriconazole intravenously with the loading dose of 6mg/Kg IV 12 hourly for 2 days followed by 4mg/Kg 12 hourly for 7 days. After 7 days of treatment, patient recovered well. Post-operative follow-up and post-operative radiography did not show evidence of any recurrence.Conclusion: This rare case of fungal etiology in patient having renal stones reveals the importance of closely monitoring postoperative patients, even when typical infection risk factors are absent.Keywords: Aspergillus, renal stone, immunocompetent