amphotericin-b and Bladder-Exstrophy

Fungal infection of the kidneys is a rare condition that has been reported in premature babies and in diabetic or immunocompromised adult patients. Candida spp. is the most frequent micro-organism involved. This paper reports a case of an immunocompetent newborn with a bladder exstrophy who suffered from an acute renal failure caused by bilateral renal aspergilloma (Aspergillus flavus). The newborn was treated with amphotericin B urinary tract irrigation through bilateral nephrostomy catheters, combined with liposomal amphotericin B and voriconazole therapy, which improved his renal function. However, due to persistent fungal colonization, a long antifungal treatment and permanent ureterostomies were necessary to deal with new episodes of ureterorenal obstruction. As of November 2009, despite the renal injuries, renal function had been conserved. The management of the mechanical obstruction and the choice of antifungal drugs are discussed in this unusual case.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bladder Exstrophy; Humans; Infant, Newborn; Male; Nephrostomy, Percutaneous; Pyrimidines; Renal Insufficiency; Treatment Outcome; Triazoles; Ureterostomy; Voriconazole