Cryptococcal Pyelonephritis

Abstract

Of four patients with cryptococcal pyelonephritis, three had taken acetylsalicylic acid and adrenal steroids for rheumatoid arthritis, and one had lymphoma. Hematuria, proteinuria and pyuria preceded symptoms of meningitis in all four, and moderate azotemia was present in each. Cryptococcus neoformans was cultured from the urine, and was visible on microscopical examination of the sediment. Autopsy in three and renal biopsy in one disclosed changes of chronic pyelonephritis associated with numerous cryptococcal organisms. Papillary necrosis was present in all four patients, and the pathological findings in one suggest that this may be an early lesion of cryptococcal pyelonephritis. One patient was successfully treated with amphotericin B. Infections with C. neoformans must be added to the differential etiologic diagnosis of papillary necrosis, chronic pyelonephritis and nonbacteriuric pyuria.