Community-acquired fungal pyelonephritis with renal infarction and gangrene of the colon: an uncommon diagnosis

Abstract

A 54-year-old male farmer with a history of long-standing uncontrolled type 2 diabetes mellitus (HbA1c 10.8) presented with a 3-week history of fever, intermittent vomiting, malaise and left flank pain for which he was treated with broad-spectrum antibiotics and oral antifungals for Candida isolated from urine culture. CT of the abdomen revealed predominant involvement of the left kidney and retroperitoneal structures. Nephrectomy was performed due to worsening abdominal pain and features of bowel perforation found on imaging. Pus culture from the necrotic kidney grew aseptate fungal hyphae, and the histopathological examination was suggestive of zygomycosis. He received amphotericin B postoperatively, but his condition deteriorated and he succumbed to nosocomial gram-negative septicaemia.