Images in Nephrology Renal allograft pyelonephritis and fungemia due to Candida krusei

A 61-year-old female was admitted for fever and acute renal failure 6 weeks after receiving a kidney transplant. Her past medical history was notable for CKD stage 5 due to chronic idiopathic tubulointerstitial nephritis. This was diagnosed in 1998 when she presented with an elev-ated creatinine, sterile pyuria and proteinuria, and under-went native kidney biopsy confirming the diagnosis. She was initially treated with corticosteroids and remained on 5 mg daily of prednisone up until the date of her pre-emptive living related kidney transplant. She had a low-risk immunologic profile with a negative T and B cell crossmatch prior to transplant. Per our center protocol, she received basiliximab for induction, and was main-tained on tacrolimus, mycophenolate and prednisone for immunosuppression, with trough FK506 levels rangin