A Hidden Culprit: Fungal Ball Causing Obstructive Pyelonephritis in a Healthy Child – The Role of Early Drainage and Definitive PCNL

Fungal pyelonephritis is an uncommon but serious renal infection in children, particularly when complicated by obstructive uropathy. If not promptly recognized and treated, it can progress to life-threatening sepsis and irreversible renal impairment. We report a case of a 5-year-old girl with obstructive fungal pyelonephritis with large intrapelvic fungal ball. The patient was successfully managed through a staged interventional approach involving urgent percutaneous nephrostomy (PCN) to relieve obstruction and sepsis, followed by definitive fungal mass clearance via percutaneous nephrolithotomy (PCNL). This case underscores the importance of a multidisciplinary approach involving early imaging, prompt antifungal therapy, and timely surgical intervention to ensure optimal outcomes.