Management of a Fungal Perinephric Abscess (PNA): Dilemma Revisited

Candida species can cause a wide variety of clinical syndromes, especially in immunocompromised and diabetic patients. Primary perirenal candidial abscess has been a rare reported entity. Here we report a rare case of primary PNA due to Candida species in an immunocompetent patient with diabetes mellitus and its minimal invasive management. Retrospective and prospective analysis of clinical, laboratory and radiological records along with continued follow up of patient was done. This patient was 48-year-old man, admitted with burning in micturition, right flank discomfort and low grade fever since 1 year. Abdominal ultrasound and computerized tomography were suggestive of a PNA of the right kidney. Candida species was isolated from sample obtained by C.T. guided needle aspiration. Culture of aspirate showed sensitivity to azoles. Systemic antifungal therapy based on culture report was started in form of oral drug. The patient responded well leading to resolution of lump and the fever. Appropriate timely treatment appears to be having a promising role in definitive therapy for renal and PNA due to Candida even in immunocompetent host with predisposing factors such as diabetes mellitus. This case highlights the fact that fungal infections should be included in the differential diagnosis of PNA in such patients.