Xanthogranulomatous Pyelonephritis with Pyonephrosis and Renal Abscess in a Young Adult: A Consequence of Neglected Urinary Tract Infection Leading to Nephrectomy
Keywords:
Xanthogranulomatous pyelonephritis, pyonephrosis, renal abscess, Proteus mirabilis, nephrectomyAbstract
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis, which is challenging to diagnose because its clinical presentation mimics other entities and is commonly associated with a history of urinary tract obstruction. We report a case of XGP in a young adult without nephrolithiasis and urinary tract obstruction. A 23-year-old woman presented with intermittent abdominal pain in the right upper quadrant persisting for the last ten months. The pain was dull, poorly localized, and started spreading to the right back, right shoulder, and right thigh in the last three months. Other complaints included fever, chills, pain during urination, and nausea. The patient had a history of infrequent urination, recurrent urinary tract infections (UTIs), and a low fluid intake. A physical examination revealed that the patient had right upper quadrant abdominal tenderness and right costovertebral angle tenderness. Laboratory findings showed leukocytosis and neutrophilia. The radiological examination revealed a round mass in the superior pole of the right kidney with mixed cystic and solid components, and a well-defined margin. It further enlarged from 4.5 cm to 10.6 cm in diameter in three months. The urologist performed a total right nephrectomy. The histopathological examination showed XGP with renal abscess. Proteus mirabilis was identified from the pus specimen culture. XGP should be considered in the diagnosis of patients having chronic UTI presented with or without the findings of urinary tract obstruction.References
Dell’Aprovitola N, Guarino S, Del Vecchio W, et al. Xanthogranulomatous pyelonephritis mimicking a renal cell carcinoma: a unique and challenging case. Acta Radiol Short Reports. 2014;3(1):1-4.
Ichaoui H, Saadi A, Chakroun M, et al. Xanthogranulomatous pyelonephritis in adults: clinical, biological, radiological and therapeutic main findings in diffuse and focal forms. About 42 cases. Tunis Med. 2018;96(8):495–500.
Kundu R, Baliyan A, Dhingra H, et al. Clinicopathological spectrum of xanthogranulomatous pyelonephritis. Indian J Nephrol. 2019;29(2):111–5.
Gupta S, Araya CE, Dharnidharka VR. Xanthogranulomatous pyelonephritis in pediatric patients: case report and review of literature. J Pediatr Urol. 2010;6(4):355–8.
Chlif M, Chakroun M, Ben Rhouma S, et al. Xanthogranulomatous pyelonephritis presenting as a pseudotumour. Can Urol Assoc J. 2016;10(1–2):36.
Kim SW, Yoon BI, Ha US, et al. Xanthogranulomatous pyelonephritis: clinical experience with 21 cases. J Infect Chemother. 2013;19(6):1221–4.
Morales C, Opazo V, Bassa C, et al. Xanthogranulomatous pyelonephritis: A case report. Urol Case Reports. 2018;19(1):65–6.
El Abiad Y, Dehayni Y, Qarro A, et al. Xantogranulomatous pyelonephritis: The missed diagnosis. Int J Surg Case Rep. 2016;18:21-3.
El-Asmar JM, Ghanem R, Ghandour R, et al. Postpartum xanthogranulomatous pyelonephritis: a case report. Case Reports in Women’s Health. 2019;22:e00112.
Hooton TM, Vecchio M, Iroz A, et al. Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: a randomized clinical trial. JAMA Intern Med. 2018;178(11):1509–15.
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The authors who publish in this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.
