SILENT INVADER AFTER INSTRUMENTATION: CONCURRENT PRIMARY RENAL ASPERGILLOSIS AND SEPTIC ARTHRITIS

 

*Sathesini Priya AS, Subashini V, Saro Thanga Sangeetha, Darshana ML

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ABSTRACT:

Primary renal aspergillosis is a rare and invasive clinical entity defined by isolated fungal involvement of the kidneys without prior or concurrent systemic infection, often presenting with non-specific symptoms such as lumbar pain, fever, and painful voiding that mimic bacterial pyelonephritis. While the condition is often associated with immunocompromised states, it can also manifest in immunocompetent individuals following local predisposing factors such as urinary tract instrumentation, endoscopic surgery, or orthopedic procedures. The pathogenesis in these cases often involves the introduction of fungal spores via contaminated medical instruments or inadequate sterilization, which may result in localized renal infection and even concurrent septic arthritis.  Case: Here we discuss a case of primary renal aspergillosis with bilateral septic arthritis, the diagnosis of which is usually confirmed through a combination of radiological findings, microbiological investigation. Microscopy typically reveals narrow, septate hyaline hyphae with acute-angle branching, while cultures frequently identify Aspergillus flavus as the causative pathogen. Conclusion: Successful management requires surgical decompression, such as percutaneous nephrostomy (PCN) or stent removal, followed by targeted antifungal therapy with voriconazole, which has proven highly effective in restoring renal function.

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Keywords: Primary renal aspergillosis, septic arthritis, Aspergillus flavus, immunocompromised, voriconazole.

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