Case of the Month - May 2019 Case of the month archive 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? Figure 1: PAS stain of kidney biopsy. Figure 2: urine culture after 72 hours of incubation on fungal growth media.