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A 62-year-old man was admitted for his first renal transplantation in August 2001. Immunosuppressive therapy consisted of anti-thymocyte globulin, ciclosporin A, mycophenolate mofetil and steroids. On Day 1 post-transplantation, haemorrhagic shock occurred, leading to massive blood transfusion, surgical re-intervention and delayed graft function (DGF). A large haematoma developed at the transplant site.  One month later, DGF was still present and the patient developed severe sepsis. A renal biopsy was performed and showed isolated acute tubular necrosis, explaining the DGF, and unexpectedly a few glomeruli and tubes contained yeast forms that were characteristic of Candida albicans (Figures ​(Figures11 and ​and2).2). Blood cultures were also positive for C. albicans as were transplant site haematoma cultures.    Fig. 1  Silver stain (×400) showing intraglomerular yeast (Candida albicans) (yellow arrows) in two different glomeruli associated with inflammatory reaction in the urinary chamber.      Fig. 2  PAS stain (A ×200; B × 320) showing intratubular Candida albicans (black arrows) associated with inflammatory reaction in and around the tube.    C. albicans septicaemia was treated with 15-day intravenous amphotericin B together with 1-month treatment with fluconazole and evacuation of the haematoma.  One month later (2 months after kidney transplantation), renal function had recovered, and the patient was discharged from the hospital with a plasma creatinine level of 240 μmol/l.  To the best of our knowledge, there is only one published report of intraglomerular yeast [1] in an HIV-infected patient. Our own report of severe candidaemia after kidney transplantation associated with the intra-glomerular presence of C. albicans would appear to be the only reported case to date.​date. ​  Conflict of interest statement. None declared.

A renal transplant recipient with intraglomerular Candida albicans