Candida organisms are common
fungal saprophytes of the gastrointestinal tract, oral cavity, and
vagina.1 However, if host resistance
is altered by chronic disease, malignancy, diabetes mellitus, adrenocorticosteroids, or antibiotics, Candida species may be found in sites
normally free of saprophytic infection. When these organisms become
systemic invaders of man, they
usually produce a fatal, fulminant
clinical course with candidemia,
fever, hypotension, tachycardia, and
invasion of the lungs, heart, and
kidney.2-5 On rare occasion, they
may become a primary, pathogenic
invader of the kidneys without the
presence of candidemia or other
systemic organ involvement.6 A total
of nine well-documented cases of
primary renal candidiasis in adults
have been reported since Albers7
described the first two patients in
1953.7-13
The purpose of this communication is to review the nine previous
patients with adult primary renal
candidiasis and report two additional
patients with very unusual features.
Both of our patients had juvenile
diabetes, and neither demonstrated
generalized systemic candidiasis or
candidemia. One patient presented
to the hospital after he passed on
urination several large fungus balls
which consisted of C albicans pseudomycelial elements (Fig 1 and 2).
The second patient developed a C
albicans perinephric abscess which
is believed to be the result of metastatic seeding from a previous C
albicans skin abscess. The passage
of fungus balls or the occurrence of
a perinephric abscess has not been
previously observed in primary renal candidiasis. Both patients were
treated with intravenous doses of
amphotericin B, and both have survived for a long interval with no
evidence of recurrent C albicans infection.