SHM Converge Scientific Abstract ePoster Gallery-Unmasking Renal Aspergillosis: A Rare Culprit in Immunocompromised Patients

Pdf Summary

This case describes a 29-year-old man with Crohn’s disease on adalimumab (Humira) who presented with two weeks of fever, fatigue, mild left flank pain, and nasal congestion. Initial labs showed leukocytosis and markedly elevated CRP. Standard infectious workup, including blood and urine cultures and chest X-ray, was unrevealing. CT abdomen/pelvis suggested focal pyelonephritis in the upper pole of the left kidney with a small cystic lesion concerning for an early renal abscess.<br /><br />He was treated empirically with broad-spectrum antibiotics, including vancomycin, piperacillin-tazobactam, and later meropenem, but fevers and inflammatory markers persisted. Fungal biomarkers such as beta-D-glucan, urine histoplasma antigen, and galactomannan were negative. Renal biopsy showed necrotizing and non-necrotizing granulomatous inflammation, but routine cultures and AFB stains were negative. Because renal manifestations of Crohn’s disease were considered but seemed unlikely, fungal PCR from the biopsy was pursued and returned positive for Aspergillus.<br /><br />The patient was then started on voriconazole, with clinical improvement and interval radiographic improvement on repeat CT one month later.<br /><br />The report highlights that extrapulmonary aspergillosis can occur in immunocompromised patients and that isolated renal aspergillosis is rare but carries significant mortality. Diagnosis is often difficult because cultures and serum markers have limited sensitivity. Clinicians should maintain suspicion for invasive fungal infection in immunocompromised patients with persistent fever and renal lesions that do not respond to antibiotics.

Asset Subtitle

Xinyuan Wu

Meta Tag

Author List Xinyuan Wu

Category Clinical Vignettes

Concept Extrapulmonary Aspergillosis

Concept Isolated Renal Aspergillosis

Concept Kidney Biopsy

Concept Voriconazole

Concept Renal involvement

Distinguished Non-Finalist

Presenter Organization Nyu

Presenting Author Xinyuan Wu

Track Adult

Keywords

Crohn’s disease

adalimumab

renal aspergillosis

invasive fungal infection

immunocompromised

fever

granulomatous inflammation

voriconazole

kidney abscess

Aspergillus PCR

Extrapulmonary Aspergillosis

Isolated Renal Aspergillosis

Kidney Biopsy

Voriconazole

Renal involvement