Renal aspergillosis after COVID-19-associated pulmonary aspergillosis: A case report

Roya Ghasemian; Lale Vahedi Larijani; Kimia Rasouli; Mohammad Taghi Hedayati; Chanour Tavakol; Keyvan Heydari; Hamidreza Zalpoor; Aref Hoseini

doi:10.1002/ccr3.7882

Renal aspergillosis after COVID-19-associated pulmonary aspergillosis: A case report

Clin Case Rep. 2023 Sep 7;11(9):e7882. doi: 10.1002/ccr3.7882. eCollection 2023 Sep.

Authors

Roya Ghasemian¹, Lale Vahedi Larijani^{2

3}, Kimia Rasouli⁴, Mohammad Taghi Hedayati^{5

6}, Chanour Tavakol⁷, Keyvan Heydari^{3

4}, Hamidreza Zalpoor^{8

9

10}, Aref Hoseini⁴

Affiliations

¹ Department of Infectious Disease Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences Sari Iran.
² Department of Pathology, School of Medicine Mazandaran University of Medical Sciences Sari Iran.
³ Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences Sari Iran.
⁴ Student Research Committee, School of Medicine Mazandaran University of Medical Sciences Sari Iran.
⁵ Department of Medical Mycology, School of Medicine Mazandaran University of Medical Sciences Sari Iran.
⁶ Invasive Fungi Research Center/Department of Medical Mycology, School of Medicine Mazandaran University of Medical Sciences Sari Iran.
⁷ Tehran School of Medicine Tehran University of Medical Sciences Tehran Iran.
⁸ Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences Shiraz Iran.
⁹ Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN) Tehran Iran.
¹⁰ American Association of Kidney Patients (AAKP) Tampa Florida USA.

Abstract

Key clinical message: Renal aspergillosis is a rare condition and this case the first case of Renal aspergillosis reported after COVID-19-associated pulmonary aspergillosis. Renal symptoms should arise clinical suspicion to renal involvement that happened as a result of hematogenous spreading of pulmonary aspergillosis.

Abstract: Secondary fungal infections are among the most significant complications that can arise after COVID-19 and have the potential to lead to a high rate of morbidity and mortality. As COVID-19 primarily involves the airway, the majority of fungal infections reported have been related to the respiratory system. However, renal aspergillosis that we have reported is a rare condition that also can occur. A 67-year-old man was referred to our hospital and admitted as a COVID-19 patient. After the initial recovery, he experienced a recurrence of fever accompanied by a productive cough. The histopathological studies were conducted on the sputum and bronchoalveolar lavage samples, which revealed the presence of Aspergillus flavus. We treated the patient with voriconazole and the patient was discharged after a period of time. However, after approximately 6 months, he returned to the hospital with a fever and abdominal pain. We started a fever workup. Two new hypoechoic abscess-like masses were spotted in the right kidney in the ultrasonography (U/S) and the direct molecular studies of the biopsy sample obtained under U/S guidance identified Aspergillus flavus. Although renal aspergillosis is a rare condition, it should not be overlooked, especially in patients with severe COVID-19 and pulmonary aspergillosis, as these conditions can lead to renal aspergillosis, which may present with symptoms such as abdominal pain with fever. Therefore, it is necessary to perform radiological and histopathological studies when renal aspergillosis is suspected.

Keywords: COVID‐19; aspergillus flavus; case report; pulmonary aspergillosis; renal aspergillosis; voriconazole.

Publication types

Case Reports