Overlapping presentation of fungal tubulointerstitial nephritis in an immunosuppressed pediatric patient

Abstract

With the expanding use of immunosuppressive therapies and broad-spectrum antibiotics, Candida species has become an increasingly important cause of infections, particularly in the presence of anti-tumor necrosis factor-alpha therapy. We report the case of a 17-year-old female with ulcerative colitis who developed oliguric renal failure following immunosuppressive and nephrotoxic therapy. Although urine cultures and urinary tract imaging were negative in the face of fungemia, renal biopsy was the key to establishing the diagnosis of fungal tubulo-interstitial nephritis as the primary reversible cause of the renal failure.

Fig. 1

Masson’s trichrome staining of the kidney reveals severe tubulointerstitial disease and a relatively normal glomerulus. Magnification ×100. Insert Fungal organisms (arrows) and neutrophils are present in the tubules and adjacent interstitium. Periodic acid-Schiff stain, magnification ×200