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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 3  |  Page : 597-598
Irreversible fatal renal failure resulting from isolated renal mucormycosis


Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

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Date of Web Publication20-May-2015
 

How to cite this article:
Al-Mendalawi MD. Irreversible fatal renal failure resulting from isolated renal mucormycosis. Saudi J Kidney Dis Transpl 2015;26:597-8

How to cite this URL:
Al-Mendalawi MD. Irreversible fatal renal failure resulting from isolated renal mucormycosis. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Jun 14];26:597-8. Available from: https://www.sjkdt.org/text.asp?2015/26/3/597/157410
To the Editor,

I have two comments on the interesting case report by Sathe and Mehta. [1]

Firstly, mucormycosis (MM) continues to be a devastating invasive fungal infection, carrying high mortality rates even after active management. The disease is being reported at an alarmingly increased frequency over the past decades from India. [2],[3] It is well known that MM usually occurs in immune-compromised individuals with identifiable risk factors. However, its occurrence in immune-competent individuals has been increasingly reported over the past years. Considering the different forms of MM, isolated renal mucormycosis (IRMM) is a very rare form and has emerged as a new clinical entity. [3] Among the identifiable risk factors contributing to bilateral IRMM presenting with renal failure, particularly in developing countries, human immunodeficiency virus (HIV) infection ought to be seriously considered. [4] In India, increasing numbers of children affected by HIV are being recognized. [5] It appears that Sathe and Mehta [1] did not attempt to totally exclude HIV infection in their reported patient. This is important as it will alter the management of the affected patient. The treatment of HIV patients with MM and renal failure involves hemodialysis, nephrectomy, and intravenous (i.v.) amphotericin as well as anti-retroviral therapy.

Secondly, the optimum treatment of IRMM is still controversial. Both modalities of treatment, namely surgical treatment with nephrectomy, [6] or medical treatment with i.v. amphotericin B [7] have been reported to be successful. Although the studied patient expired, I do agree with Sathe and Mehta [1] in their sound decision of treating their patient with i.v. amphotericin B and bilateral nephroureterectomy as such combined therapy appears more likely to eradicate the infection, relieve pain and constitutional symptoms and minimize the risk of disseminated MM.

Conflict of Interest: None.

Authors Reply

To the Editor,

The HIV test of the patient reported in this presentation was negative.

We agree about your comments regarding poor prognosis despite intravenous antifungal therapy and surgery in renal mucormycosis MM.

Dr. Kumud Mehta
Department of Pediatrics, Jaslok Hospital and Research Center, Mumbai - 400 026, India
E-mail: [email protected]

 
   References Top

1.
Sathe KP, Mehta KP. Irreversible fatal renal failure resulting from isolated renal mucormycosis. Saudi J Kidney Dis Transpl 2014;25: 1312-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Nayagam LS, Vijayanand B, Balasubramanian S. Isolated renal mucormycosis in an immunocompetent child. Indian J Nephrol 2014;24: 321-3.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Chakrabarti A, Singh R. Mucormycosis in India:Unique features. Mycoses 201;57(Suppl 3):85-90.  Back to cited text no. 3
    
4.
Guardia JA, Bourgoignie J, Diego J. Renal mucormycosis in the HIV patient. Am J Kidney Dis 2000;35:E24.  Back to cited text no. 4
    
5.
Singh HK, Gupta A, Siberry GK, et al. The Indian pediatric HIV epidemic: A systematic review. Curr HIV Res 2008;6:419-32.  Back to cited text no. 5
    
6.
Singh AK, Goel MM, Gupta C, Kumar S. Isolated renal zygomycosis in an immunocompetent patient. BMJ Case Rep 2014 Jun 5; 2014.  Back to cited text no. 6
    
7.
Pahwa M, Pahwa AR, Girotra M, Chawla A. Isolated renal mucormycosis in a healthy immunocompetent patient: Atypical presentation and course. Korean J Urol 2013;54:641-3.  Back to cited text no. 7
    

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Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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DOI: 10.4103/1319-2442.157410

PMID: 26022037

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