Case Report: Continuous antegrade liposomal amphotericin B irrigation as an adjunct to endoscopic management of a refractory renal fungal bezoar
- 1Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
- 2Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- 3Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
Abstract
BackgroundObstructing renal fungal bezoars are rare but challenging complications of upper urinary tract candidiasis. Systemic antifungal therapy alone is often inadequate because of the high fungal burden and associated urinary obstruction. Current guidelines recommend urinary decompression, source control, systemic antifungal therapy, and adjunctive local amphotericin B deoxycholate irrigation through a nephrostomy tube when available. However, published experience with continuous antegrade liposomal amphotericin B irrigation is extremely limited.Case descriptionWe describe a 26-year-old female patient with spina bifida, neurogenic bladder, recurrent urinary tract instrumentation, and a presumed right staghorn calculus who was found to have a large obstructing right renal fungal bezoar. Following failure of systemic fluconazole and incomplete mechanical fragmentation during retrograde ureteroscopy, continuous antegrade liposomal amphotericin B irrigation (100 mg in 500 mL of 5% dextrose at 20 mL/hour) was administered through a nephrostomy tube for 6 days. Repeat endoscopic intervention demonstrated a markedly softer and less adherent fungal bezoar, allowing uncomplicated complete removal. The patient experienced no treatment-related adverse events and recovered uneventfully.ConclusionThis case describes the use of continuous antegrade liposomal amphotericin B nephrostomy irrigation as an adjunctive treatment for refractory obstructing renal fungal bezoar. Although the independent effect of local irrigation cannot be established from a single case, the observed intraoperative change in bezoar consistency suggests a potential therapeutic benefit. Additional clinical experience and prospective studies are needed to define its optimal administration, safety, and efficacy.
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BibTeX
@article{ghaziri2026case,
title = {{Case Report: Continuous antegrade liposomal amphotericin B irrigation as an adjunct to endoscopic management of a refractory renal fungal bezoar}},
author = {Dania Ghaziri and Alaa Balaghi and Ghassan Al Awar and Jad Hamawi and Maher Abdessater},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1965455},
url = {https://doi.org/10.3389/fmed.2026.1965455},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Continuous antegrade liposomal amphotericin B irrigation as an adjunct to endoscopic management of a refractory renal fungal bezoar
AU - Dania Ghaziri
AU - Alaa Balaghi
AU - Ghassan Al Awar
AU - Jad Hamawi
AU - Maher Abdessater
PY - 2026
DA - 2026/10/23
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1965455
UR - https://doi.org/10.3389/fmed.2026.1965455
AB - BackgroundObstructing renal fungal bezoars are rare but challenging complications of upper urinary tract candidiasis. Systemic antifungal therapy alone is often inadequate because of the high fungal burden and associated urinary obstruction. Current guidelines recommend urinary decompression, source control, systemic antifungal therapy, and adjunctive local amphotericin B deoxycholate irrigation through a nephrostomy tube when available. However, published experience with continuous antegrade liposomal amphotericin B irrigation is extremely limited.Case descriptionWe describe a 26-year-old female patient with spina bifida, neurogenic bladder, recurrent urinary tract instrumentation, and a presumed right staghorn calculus who was found to have a large obstructing right renal fungal bezoar. Following failure of systemic fluconazole and incomplete mechanical fragmentation during retrograde ureteroscopy, continuous antegrade liposomal amphotericin B irrigation (100 mg in 500 mL of 5% dextrose at 20 mL/hour) was administered through a nephrostomy tube for 6 days. Repeat endoscopic intervention demonstrated a markedly softer and less adherent fungal bezoar, allowing uncomplicated complete removal. The patient experienced no treatment-related adverse events and recovered uneventfully.ConclusionThis case describes the use of continuous antegrade liposomal amphotericin B nephrostomy irrigation as an adjunctive treatment for refractory obstructing renal fungal bezoar. Although the independent effect of local irrigation cannot be established from a single case, the observed intraoperative change in bezoar consistency suggests a potential therapeutic benefit. Additional clinical experience and prospective studies are needed to define its optimal administration, safety, and efficacy.
SN - 2296-858X
ER -