水腎症を繰り返し発症した尿路真菌球症

Fungus balls in the urinary tract：a case report

60歳男性，インスリン依存型糖尿病の合併あり。発熱のため近医を受診，右水腎症を指摘され，近医泌尿器科を紹介された。尿路真菌球症と診断され，ダブルJステント留置と抗真菌薬内服でいったんは軽快したものの，再び右水腎症と腎盂腎炎を発症した。保存的治療で軽快しないため，当科を紹介された。尿管鏡下，生理食塩水による洗浄とバスケットカテーテルによる摘出，さらに術後抗真菌薬内服により，尿中真菌は陰性化した。

A 60-year-old man with insulin dependent diabetes mellitus was referred to a clinic because of fever and right hydronephrosis. Candida albicans was found in the urine culture. Conservative therapy including catheterization with double J stent and oral antifungal administration was momentary successful, but right hydronephrosis and fever immediately recurred after removal of the stent. Then, the patient was introduced to our hospital for prolonged mycosis of urinary tract. Trichosporon asahii was isolated in the urine culture in our hospital. Ureteroscopy revealed fungus balls in the urinary tract, which were successfully removed one by one using a basket catheter and irrigation by physiological solution. Oral antifungal agent was administered after the surgery. The postoperative course was uneventful and satisfactory without recurrence.