Scand J Urol Nephrol 24: 81, 1990

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY OF A KIDNEY STONE COMPLICATED WITH CANDZDA ALBZCANS SEPTICAEMIA AND ENDOPHTHALMITIS Case Report Henrik Westh and Peter Mogensen

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From the Department of Clinical Microbiology and the Department of Urology, Bispebjerg Hospital, Copenhagen, Denmark

Abstract. Following a routine extracorporeal shock wave lithotripsy of a kidney stone, candida septicaemia and eight days later candida endophthalmitis developed. Key words: extracorporeal shock wave lithotripsy, complication of; Candida albicans endophthalmitis; Candida albicans septicaemia.

Extracorporeal shock wave lithotripsy (ESWL) of kidney stones can be complicated by septicaemia (1). We describe a routine ESWL that was followed by candida septicaemia and eight days later candida endophthalmitis (CE). This type of infectious complication has not previously been reported. CASE REPORT A 57-year-old man underwent a routine ESWL (Siemens Lithostar) of a 12 mm x 9 mm large stone located in the lower calyx group of the left kidney. A preoperative urine culture did not reveal any microorganisms, and ESWL using 1OOO shock waves was performed without prophylactic antibiotics. No double-J stent or urethral catheter was used and the course was not complicated by ureteral obstruction. The kidney stone was completely disintegrated but was retained in a calyx cyst. The patient was discharged the following day but returned to the department after four days due to pain in the left lumbar region and fever. He was treated as an out-patient with ampicillin. Three days later the patient was readmitted as antibiotic treatment had been without any effect. Urine and blood were cultured and treatment with aztreonam was initiated. IO3-l@ Candida albicans was isolated from the urine and after three days the two sets of blood cultures also grew Candida albicans. The patient's temperature had normalized after two days of hospitalization and all clinical symptoms had disappeared, so he did not receive treatment of his candidaemia and was discharged from the hospital.

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Eight days after the candida septicaemia the patient complained of ocular pain, blurred vision, and floaters and was treated by his personal ophthalmologist for iridocyclitis of the left eye. One month later he was admitted to an ophthalmological department. CE was suspected but a diagnostic vitreous tap was negative. A course of high dose prednisolone was initiated. Visus deteriorated progressively and a vitrectomy was performed due to neovascular glaucoma. The vitreous was cultured and after 6 days grew Candida albicans. The patient was hereafter treated for three weeks with amphotericin B (Fungilin") and 5-flucytosine (AncotiP).

DISCUSSION ESWL has given rise to bacterial septicaemia (1) and endocarditis (2) and antibiotic prophylaxis is usually prescribed for the patient with a positive urine culture before ESWL. We describe the first case of candida septicaemia complicated by CE following ESWL and remind that other pathogens than bacteria may constitute a problem in these patients.

REFERENCES Coptcoat MC, Webb DR, Kellet MJ, Fletcher MS, McNicholas TA, Dickinson IK, Whitfield HN, Wickham JEA. The complications of extracorporeal shockwave lithotripsy: management and prevention. Br J Urol 1986; 58: 578-580. Kroneman OC 111, Brodsky MS, MacKenzie J, Hauser A. Endocarditis after lithotripsy. Ann Intern Med 1987; 106: 777.

Scand J Urol Nephrol24

Extracorporeal shock wave lithotripsy of a kidney stone complicated with Candida albicans septicaemia and endophthalmitis. Case report.

Following a routine extracorporeal shock wave lithotripsy of a kidney stone, candida septicaemia and eight days later candida endophthalmitis develope...
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