Abstract

We report a 56-year-old male patient with diabetes mellitus type 2 for 15 years who referred to our hospital with a history of left-side pain for 2 months, 10 kilograms of weight loss in the last 3 months and intermittent fever attacks over 38°C for 4 weeks. The results of laboratory tests including complete blood count, kidney and liver functions, and blood electrolytes turned out to be normal. C-reactive protein (CRP) was high as 158 mg/L but no microorganism was identified in urinary and blood cultures. In abdominopelvic computerized tomography (CT), a cystic lesion was observed at the left kidney. The result of indirect hemagglutination test for hydatid cyst was negative. Because of the risk of malignancy, left radical nephrectomy with subcostal chevron incision was performed. During the operation, a lesion on the anterior part of the kidney filled with purulent fluid was observed and drained. Histopathological examination revealed a kind of xanthogranulomatous pyelonephritis and microscopic examination with hematoxylin and eosin displayed branching septate hyphae. Galactomannan antigen was detected in necrotic material with latex agglutination test and Aspergillus fumigatus was isolated in the culture. Thoracal and cranial CTs, echocardiography and ophthalmic examination were normal. An oral therapy of 100 mg itraconazole 2 times a day for 6 weeks was given. Post-therapy CRP was normal and no lesion was identified at the control CT. As a result, fungal infections, especially aspergillosis should be kept in mind in immunodeficient patients or patients with comorbidities like diabetes mellitus with a renal mass.