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Case Report: Continuous antegrade liposomal amphotericin B irrigation as an adjunct to endoscopic management of a refractory renal fungal bezoar

Year: 2026

Type: article

Abstract: Background Obstructing 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 description We 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. Conclusion This 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.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1965455

Authors: Dania Ghaziri, Alaa Balaghi, Ghassan Al Awar, Jad Hamawi, Maher Abdessater

Institution: American University of Beirut Medical Center

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801