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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:507-514 • 0278-4297

Case Series

Primary Renal Candidiasis

Importance of Imaging and Clinical History in Diagnosis and Management

Barry J. Sadegi, MD, Bhargavi K. Patel, MD, Andrew C. Wilbur, MD, Anil Khosla, MD and Ejaz Shamim, MD

Department of Radiology, University of Illinois, Chicago, Illinois USA (B.J.S., B.K.P., A.C.W., E.S.); and Veterans Administration Medical Center, John Cochran Division, St Louis, Missouri USA (A.K.).

Address correspondence and to Bhargavi K. Patel, MD, Department of Radiology, University of Illinois, 1740 W Taylor St, M-C 931, Room 2483, Chicago, IL 60612 USA.

Objective. Primary renal candidiasis is rare but increasing in incidence. The purpose of this series is to provide imaging and clinical findings for diagnosing candidiasis and to discuss imaging in the management of this disease. Methods. Ten sonographic, 8 retrograde pyelographic, 2 intravenous pyelographic, 2 antegrade pyelographic, and 2 computed tomographic examinations of 5 patients (4 adult male patients and 1 16-year-old female patient) were reviewed. Results. The clinical presentation was variable. Sonography showed renal pelvic wall thickening (n = 5), echogenic debris (n = 4), and fungus balls (n = 2). Papillary necrosis (n = 4), filling defects due to debris (n = 3), and fungus balls (n = 2) were seen on retrograde pyelography. Conclusions. Untreated candidiasis may progress to fungus ball or abscess formation. Sonography is commonly used as the initial imaging procedure. Retrograde and antegrade pyelography are used for biopsy, diagnosis, and treatment. Awareness of this condition and knowledgeable imaging evaluation can help detect and define the site, infection severity, and subsequent therapy.

Key Words: fungus ball • papillary necrosis • pyelography • renal candidiasis • sonography

Abbreviations: CT, computed tomography • HIV, human immunodeficiency virus

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