Reactions 1704, p76 - 2 Jun 2018 Various toxicities: case report A 77-year-old man developed mycotic renal stone, Candida albicans (C. albicans) urinary tract infection (UTI), pyelonephritis, atrial fibrillation, acute renal injury, hydronephrosis, bladder outlet obstruction and C. albicans septicaemia during treatment with canagliflozin for type II diabetes [dosage, route and duration of treatment to reaction onset not stated; not all outcomes stated]. The man, who had type II diabetes mellitus, was receiving treatment with canagliflozin, insulin and metformin. In September, he presented to the hospital with urinary symptoms, vomiting and nausea. Pyelonephritis was diagnosed requiring hospitalisation. The man was then discharged on levofloxacin. A urine sample showed the presence of yeast only due to the initiation of levofloxacin. An imaging study demonstrated non- obstructing renal stones, which he was able to strain and send for pathology upon spontaneous passing. On day 12 of levofloxacin therapy, he developed vomiting and purulent discharge from the urethra. He came back to the hospital. Subsequently, urine and blood cultures revealed the presence of C. albicans. On admission, he was treated with fluconazole. He developed new-onset atrial fibrillation and acute renal injury. Imaging revealed bladder outlet obstruction and left hydronephrosis. He required a ureteral stent. A pyelogram and ureteroscopy showed copious fungal material in the left upper urinary tract. He was diagnosed with C. albicans UTI. A pathology of the renal stones confirmed the presence of a fungal ball seeded on a calcium oxalate stone, which led to a diagnosis of a mycotic renal stone. He was also noted to have C. albicans septicaemia. He was discharged on fluconazole, and his canagliflozin therapy was discontinued. Two weeks later, repeat blood cultures grew candida. Therefore, the ureteral stent was removed, and the fluconazole course was extended. The last set of blood cultures was negative. Author comment: "FDA-submitted public safety reports in patients taking canagliflozin indicate an incidence of 1254 (all) fungal infections, 714 UTIs, 40 candidal UTIs, 96 pyelonephritis, 91 nephrolithiasis, 685 sepsis with 77 diagnosed as urosepsis and only 2 cases of candida sepsis.""Here we have a case of Candidemia in the setting of nephrolithiasis with a missed opportunity for early treatment of Candida UTI under the presumptive contaminant nature of yeast in urine cultures." Blloshmi K, et al. A mycotic renal stone: A case of candida septicemia with canagliflozin. Journal of the American Geriatrics Society 66 (Suppl. 2): S176-S177, 19 Apr 2018. Available from: URL: http://doi.org/10.1111/jgs.15376 [abstract] - USA 803323531 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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