Diabetic ketoacidosis from Candida urosepsis with fungus ball
2022; Wiley; Volume: 9; Issue: 1 Linguagem: Inglês
10.1002/ams2.764
ISSN2052-8817
AutoresYuta Kubono, Hirohisa Fujikawa, Yasuhisa Furuya,
Tópico(s)Pain Management and Opioid Use
ResumoAcute Medicine & SurgeryVolume 9, Issue 1 e764 Case ImageOpen Access Diabetic ketoacidosis from Candida urosepsis with fungus ball Yuta Kubono, Yuta Kubono Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan Department of Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, JapanSearch for more papers by this authorHirohisa Fujikawa, Corresponding Author Hirohisa Fujikawa hirohisa.fujikawa@gmail.com orcid.org/0000-0002-8195-1267 Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, JapanCorresponding: Hirohisa Fujikawa, MD, Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: hirohisa.fujikawa@gmail.com.Search for more papers by this authorYasuhisa Furuya, Yasuhisa Furuya Department of Urology, Suwa Central Hospital, Chino, Nagano, JapanSearch for more papers by this author Yuta Kubono, Yuta Kubono Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan Department of Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, JapanSearch for more papers by this authorHirohisa Fujikawa, Corresponding Author Hirohisa Fujikawa hirohisa.fujikawa@gmail.com orcid.org/0000-0002-8195-1267 Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, JapanCorresponding: Hirohisa Fujikawa, MD, Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: hirohisa.fujikawa@gmail.com.Search for more papers by this authorYasuhisa Furuya, Yasuhisa Furuya Department of Urology, Suwa Central Hospital, Chino, Nagano, JapanSearch for more papers by this author First published: 28 May 2022 https://doi.org/10.1002/ams2.764AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat A 76-year-old man with untreated type 2 diabetes mellitus was presented to the emergency department because of disturbed consciousness. On examination, the patient’s Glasgow Coma Scale was 12/15 (E3V4M5) and his temperature was 37.2°C. Other physical findings revealed no pathology. The laboratory data showed white cell count of 16.4 (normal range 3.5–9.1) × 109/L, C-reactive protein level of 334.1 (normal range 0–3) mg/L, blood glucose level above 40 (normal range 5.6–6.9) mmol/L, and hemoglobin A1c level of 18.5 (normal range 4.6–6.2) %. Blood gas analysis indicated an elevated anion gap with metabolic acidosis and ketosis (pH 7.35, anion gap 29.5 mmol/L, bicarbonate 9.3 mmol/L, lactate 3.44 mmol/L, and beta-hydroxybutyrate >7.0 [normal range 0.1–0.6] mmol/L). Abdominal computed tomography showed bilateral ureteral dilatation with right predominance beginning at just above the bladder. Initially, lower urinary tract obstruction was suspected, and an indwelling urinary catheter was inserted. However, abdominal ultrasonography showed that the left ureteral dilatation had improved, but the right ureter remained dilated (Fig. 1A, red arrows), with a mass lesion near the right ureteral orifice (Fig. 1B, red arrowheads). As ureteral obstruction by the mass was suspected, we decided to perform a cystoscopy. Fig. 1Open in figure viewerPowerPoint (A) Abdominal ultrasonography showed dilation of the right ureter (red arrows). (B) Abdominal ultrasonography showed a fungal ball near the right ureteral orifice (red arrowheads). (C) Cystoscopy showed a fungal ball at the right ureteral orifice. (D) Cystoscopic removal of the fungal ball was performed. (E) Gram stain of the urine showed large gram-positive cocci and pseudohyphae. Cystoscopy revealed a ball-shaped material at the right ureteral orifice, while there was no mass around the left ureteral orifice; therefore, the ball-shaped material was removed cystoscopically (Fig. 1C,D). Then, pyuria was discharged one after another from the ureteral orifice (Video S1), and we placed ureteral stent. Blood and urine culture revealed Candida albicans (Fig. 1E). Thus, he was diagnosed with diabetic ketoacidosis due to Candida urosepsis with fungus ball. He was treated with intravenous fluid, insulin, and antifungal drugs but died 10 weeks after admission. The clinical presentations of Candida range from colonization to invasive infections.1 Particularly, fungal balls are crucial clinical manifestation that can obstruct the ureters and require medical and surgical treatment.2 Although Candida urinary tract infection due to fungal ball obstruction is rare, it should be noted in patients with diabetes mellitus because it is frequently reported in those patients.3 ACKNOWLEDGMENTS None. DISCLOSURE Approval of the Research Protocol with Approval No. and Committee Name: N/A. Informed Consent: Written informed consent was obtained from the patient’s son. Registry and Registration No. of the Study/Trial: N/A. Animal Studies: N/A. Conflict of Interest: The authors declare no conflict of interest in association with the present study. Supporting Information Filename Description AMS2764-sup-0001-VideoS1.movQuickTime video, 66.9 MB Video S1. After a fungal ball was removed cystoscopically, pyuria was discharged one after another from the right ureteral orifice. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. References 1Gajdács M, Dóczi I, Ábrók M, Lázár A, Burián K. Epidemiology of candiduria and Candida urinary tract infections in inpatients and outpatients: results from a 10-year retrospective survey. Cent. European J. Urol. 2019; 72: 209– 14. PubMedWeb of Science®Google Scholar 2Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections – epidemiology. Clin. Infect. Dis. 2011; 52: S433– 6. CrossrefPubMedWeb of Science®Google Scholar 3Stein J, Latz S, Ellinger J et al. Fungaemia caused by obstructive renal candida bezoars leads to bilateral chorioretinitis: a case report. BMC Urol. 2018; 18: 21. CrossrefPubMedGoogle Scholar Volume9, Issue1January/December 2022e764 FiguresReferencesRelatedInformation
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