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• W2014781283 abstract "Bezoar formation is a rare complication of fungal urinary tract infections. Predisposing factors include diabetes mellitus, neurogenic bladder, indwelling Foley catheter, steroid therapy, and broad-spectrum antibiotics use. Furthermore, hypertonicity and acidic conditions facilitate mycelial proliferation in the bladder. Radiographs may reveal cabbage-like bladder masses with curvilinear opacities separated by thin strips of air. Obstructive uropathy and bladder rupture may be potential complications. We present the first case of bladder rupture attributed to a Candida albicans bezoar. A 79-year-old diabetic man with neurogenic bladder and indwelling Foley catheter presented with 4 days of fever and altered mentation. His examination was notable for fever to 103°F and tachycardia at 120/min. Creatinine of 3.5 mg/dL and BUN of 64 mg/dL were increased from his normal baseline. Urinalysis showed pyuria and numerous yeasts. Urine culture yielded >100,000 cfu of C. albicans. Blood cultures yielded no growth. The patient was treated with intravenous fluconazole and amphotericin bladder irrigation, and his Foley catheter was changed. Because of persistent fever, pyuria, and funguria, he underwent cystoscopy and the cystometrogram showed a large filling defect in the bladder. On the third day of hospitalization, he developed acute abdominal pain and distension with abdominal roentgenograms revealing free air under the diaphragm. Exploratory laparotomy confirmed intraperitoneal bladder rupture, and a large bezoar firmly adherent to the bladder wall was removed. Direct examination of the specimen with 10% potassium hydroxide showed accretions of hyphae, and a culture yielded C. albicans. The patient became afebrile after surgery, and his renal function returned to normal. He completed a 4-week course of fluconazole 200 mg/day. Our review of the literature since 1966 found eight other cases of bladder fungal bezoars among all age groups. Table 1 summarizes all the patients. Although uretero-pelvic bezoars are more common in neonates and transplant patients with fungemia, 78% of bladder bezoars occurred in adults. The majority of patients (89%) had an underlying or predisposing condition. Common features included renal insufficiency in 44%, dysuria in 33%, and urinary obstruction in 33%. Bezoars required surgical removal in 78%. Among the fungi isolated, Candida was reported in five cases and Aspergillus in two cases. Mortality in this series was 22%. Fungal bezoars should be suspected in patients with renal insufficiency, urinary obstruction, and persistent funguria. Rapid and early diagnosis is essential to prevent catastrophic consequences. Early urologic consultation is required in such cases, because surgical intervention is frequently needed.TABLE 1: Summary of cases of fungal bezoars in the bladder" @default.
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• W2014781283 date "2001-06-01" @default.
• W2014781283 modified "2023-09-27" @default.
• W2014781283 title "Bladder Rupture Attributed to Candida albicans Bezoar" @default.
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• W2014781283 doi "https://doi.org/10.1097/00019048-200106000-00006" @default.
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