Renal Candidal Bezoar in an SGLT2 Inhibitor User with an Indwelling Ureteral Stent: A Case Report and Review of Literatures.

Abstract

Renal candidal bezoar is a rare cause of obstructive pyonephrosis and usually occurs in patients with diabetes mellitus, immunosuppression, urinary obstruction, or indwelling urinary devices. We report an 88-year-old man with type 2 diabetes treated with dapagliflozin, stage 3 chronic kidney disease, and a history of ureteral stricture managed with ureteral stenting who developed recurrent candidal pyonephrosis and extensive fungal bezoar involving the ureter and renal pelvis. Initial treatment at a referring hospital included percutaneous nephrostomy drainage, fluconazole therapy, ureteroscopic ureterotomy, and ureteral stent placement. The patient re-presented with fever and pyonephrosis and was presented to our emergency department. Dapagliflozin was discontinued, the ureteral stent was exchanged, and fluconazole with short course flucytosine was administered pending susceptibility testing. Cultures confirmed fluconazole-susceptible Candida albicans. Staged ureteroscopic debridement using forceps and aspiration achieved complete clearance, followed by renal functional recovery and clinical resolution. This case highlights the need to reassess medication-associated glycosuria, indwelling stent exposure, and mechanical source control in refractory upper-tract candidal bezoar. A review of reported cases suggests that drainage and antifungal therapy are essential, but active endoscopic, percutaneous, or surgical removal is frequently required when organized fungal material persists.