PEDIATRICS Vol. 81 No. 6 June 1988, pp. 826-829
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Bladder Fungus Ball: A Reversible Cause of Neonatal Obstructive Uropathy

Barbara Baetz-Greenwalt MD1, B. Debaz MD1, and Mary L. Kumar MD1

1 From the Case Western Reserve University School of Medicine, Departments of Pediatrics and Radiology, Cleveland Metropolitan General Hospital, Cleveland

Very low birth weight infants often have multiple predisposing conditions for the development of invasive candidiasis. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungus balls"), usually at the ureteropelvic junction. Ureteropelvic junction obstructive fungal uropathy necessitates invasive debridement to restore renal function. A very low birth weight infant, infected with Candida, was first seen with hypertension, renal insufficiency, and urine cultues positive for fungus; obstructive bladder fungus ball was diagnosed by ultrasography. Mechanical disruption with amphotericin B bladder irrigation was accomplished via ultrasographic guidance, relieving renal obstruction and insufficiency. Systemic antifungal therapy was completed with amphotericin B and flucytosine. The first reported case of bladder obstructive fungal uropathy in a neonate is added to a review of 16 cases of neonatal renal obstructive uropathy.

Key Words: neonatal obstructive uropathy • bladder fungus ball

Submitted on February 26, 1987
Accepted on July 15, 1987