Urinary Obstruction Due to Fungal Infection in Two Preterm Siblings

Extravasation of urine and formation of urinoma is rare in the absence of either trauma or congenital anomalies. Fungal ball formation in urinary tract can cause obstruction leading to extravasation. We present two such cases in siblings. Case One: Triplet II referred from the Neonatal unit with clinical picture of acute abdomen. Imaging was inconclusive therefore he proceeded to an exploratory laparotomy, where a diagnosis of urinary ascites was made. Candida albicans infection was confirmed on urine culture. He was treated with antifungals and made a full recovery. No structural anomalies were demonstrated on renal tract imaging. Case Two: Triplet I presented to ED one month later with symptoms of respiratory infection. Commenced on empirical antibiotic medications but clinically deteriorated. Urine culture was positive for fungal infection so antifungal medication was commenced as well. USS demonstrated a right perinephric urinoma. This was drained percutaneously. He made a good recovery and no structural anomalies were demonstrated on renal tract imaging. Although there is no other direct link between the two cases, that the patients are siblings may suggest a congenital factor. Anyhow, early recognition is vital in managing these complicated patients. Further study is required to explore the concept of a potential familial predisposition for the condition.