Fungal Balls Mimicking Renal Calculi: A Zebra Among Horses

Background: Fungal masses (fungal ball or bezoars) rarely present as renal calculus. More so, Trichosporon species are even more uncommon among the noncandidial fungal infections affecting urinary tract. We report two such interesting cases that are not yet reported in the current literature. Case Reports: Our first case is a 48-year-old gentleman with diabetes presented with fever and flank pain. He was found to have bilateral obstructing radiolucent renal calculi with azotemia. Initially managed with bilateral Double-J stenting after one session of hemodialysis, and subsequently bilateral percutaneous nephrolithotomy (PCNL) was accomplished. Our second patient is a 37-year-old lady presented with bilateral flank pain with no comorbidity or sepsis. On evaluation, she was found to have bilateral radiolucent staghorn calculi and for which bilateral PCNL was performed. In view of high suspicion of fungal infection, extracted soft floppy materials were sent for fungal culture and were treated with antifungal agents after Trichosporon species was detected. Conclusion: Although renal fungal infections are rare, a strong suspicion and timely definitive management of such entities in patients with radiolucent renal calculus can prevent devastating invasive disease.

Keywords: Trichosporon spp; fungal balls; percutaneous nephrolithotomy; renal stones.