Case of the Month - May 2019
A 53 year old man from Ghana with end-stage renal disease due to diabetic nephropathy underwent a kidney transplant from a deceased donor. His postoperative course was complicated by delayed graft function and a peritransplant hematoma that required a laparotomy and washout.
One month later, he was hospitalized with acute renal failure and low-grade fevers. A PAS stain from a section of his kidney biopsy is shown in Figure 1. A serum Fungitell level was >500.
A routine urine culture yielded no growth. The Microbiology Laboratory retrieved the urine specimen and subcultured it on fungal media. Figure 2 demonstrates growth after 72 hours.
- Name the fungus.
- What distinctive characteristic of the fungus is present on the PAS stain?
- How many hours are routine bacteriology urine cultures incubated? For transplant recipients, what other culture should have been ordered?
- Was the β-D glucan assay accurate?
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Figure 1: PAS stain of kidney biopsy.
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Figure 2: urine culture after 72 hours of incubation on fungal growth media.