Fungus Balls Due to Candida tropicalis

A 56-year-old Caucasian male was treated for labrynthitis and prescribed meclizine and prednisone without success a week prior to admission. He denied fever or chills. The laboratory examination was significant for WBC 11,000 per mm3; blood glucose level 569 mg/dL; creatinine level of 3.1 mg/dL; and BUN 53 mg/dL. His urine analysis and culture showed Candida tropicalis 105 cfu/mL. Due to acute renal failure, a retroperitoneal ultrasound was done, which showed bilateral pelvic caliectasis and hydroureter (Fig. 1). There was intra-ureteral tumefactive debris noted within the left ureter (Fig. 2). Considerations included renal candidiasis, renal pelvic hemorrhage or sloughed renal papilla/necrotizing papillitis. Focal thickening or partially obstructing debris was also noted at the left and right ureterovesical junction