血行性腎カンジダ症による急性腎不全を合併した胃幽門部癌の1例

Abstract

A 67-year-old man was referred to our hospital because of high-grade fever and acute renal failure on January 11, 1996. Gastroduodenal fiberscopy performed 17 days before admission revealed advanced gastric cancer in the pylorus. Intravenous hyper- alimentation was started on December 27, 1995. Because of the fever, the patient had been treated with 5mg/day of indomethacin and 2g/day of cefazolin since January 1, 1996. Serum creatinine was elevated to 8.2mg/dl. To rule out acute interstitial nephritis caused by these drugs, a renal biopsy was performed on the second hospital day. The biopsy specimen demonstrated multiple microabscesses containing yeast-like organisms in the medulla. Candida tropicalis was isolated from urine cultures, atrial blood and the catheter tip. The patient was diagnosed as having acute renal failure due to renal candidiasis. Under hemodialysis treatment, he received 400mg/day of miconazole. Hemodialysis was stopped on the 13th hospital day. On the 41st hospital day, the patient was afebrile and serum creatinine had decreased to 1.7mg/dl. We present a case of acute renal failure due to renal moniliasis caused by hematogenous infection with Candida tropicalis, and discuss the related literature.