Urinary Sporotrichosis in a Renal Allograft Recipient

Dr. Sanjay K. Agarwal, Assistant Professor, Department of Nephrology, Aiims, New Delhi-110029 (India) Dear Sir, We are reporting a case of urinary sporotrichosis in a renal transplant recipient. The patient had a radiolucent calculus with recurrent urinary tract infection. A 23-year-old male, having chronic glo-merulonephritis with end-stage renal failure underwent renal transplantation in July 1985. His mother was the donor with one haplotype match with the recipient. Postoperatively his renal function did not improve steadily. Ultrasound examination of the abdomen showed moderate hydronephrosis of the graft with narrowing of the lower end of the ureter. After confirming the finding on radionucleid scan on the 7th postoperative day, he was reoperated and a ureteroneocystostomy was done. Postoperatively he developed supra-pubic urinary leak which was managed conservatively. Following surgery his renal function improved slowly and on the 17th postoperative day serum creatinine was 106 μmol/l (1.2 mg/dl). He continued to have recurrent urinary tract infections which were treated according to the urine culture and sensitivity. On the 75th day following transplantation, a follow-up ureterocystoscopy was done which was essentially normal. However, his symptoms of lower urinary tract infection continued to persist even though the urinary cultures were repeatedly normal. In April 1986, although a plain radiogram of the abdomen was normal, the patient passed a stone per urethra, which was mainly made of ammonium phosphate with traces of calcium and oxalate. Keeping the possibility of a radiolucent calculus he was admitted for investigations. While in the hospital, he had acute retention of urine associated with enlargement of the graft which spontaneously got relieved within 12 h. However, a repeat ultrasonogram still showed hydroureterone-phrosis of the allograft with an echoic shadow at the lower end of the ureter. An antegrade pyelography performed at this time showed a dilated ureter (1.2 cm) and a stone at the lower end of the ureter. As the stone could not be dislodged, a percutaneus nephrostomy was done. Once the acute stage was over, he was operated for ureterolithotomy. During surgery multiple small yellowish calculi were found at the lower end of the ureter with a large stone 2 cm proximal to the vesicour-eteric junction