A Case of Pyelonephritis Caused by Candida glabrata Successfully Treated with Liposomal Amphotericin B

Abstract

Amphotericin B is recommended for the treatment of pyelonephritis caused by Candida glabrata. However, as its nephrotoxicity is well known, liposomal amphotericin B (L-AMB) was developed to reduce the adverse effects. There have been few reports of L-AMB as a treatment for urinary tract infection. One reason is its low excretion rate in urine. We report the first case of pyelonephritis caused by C. glabrata successfully treated with L-AMB.

In 2011, a 52-year-old diabetic woman developed pyelonephritis and renal abscess caused by C. glabrata after transurethral ureterolithotripsy, which was treated with oral fluconazole administration for 12 days. Residual fragments of renal pelvic calculus then gradually increased and caused intermittent asymptomatic candiduria with C. glabrata.

In 2015, a week after right ureteral stenting for a ureteral stone, the patient was hospitalized for management of a fever and left lumbar pain. A left ureteral stone had caused hydronephrosis and pyelonephritis, and left ureteral stenting was thus performed. Fluconazole was administered intravenously for pyelonephritis with C. glabrata for 3 days, but failed to control the high-grade fever, and was thus discontinued. L-AMB administration for 11 days treated the pyelonephritis successfully. Although slight increases in serum creatinine and blood urea nitrogen levels and a serum potassium decrease were observed, no treatments were necessary.

L-AMB is highly concentrated in renal tissue and plasma, which may account for its efficacy in treating pyelonephritis, which is an infection of the renal parenchyma.