Abstract
Xanthogranulomatous pyelonephritis is an uncommon chronic destructive disease process of renal parenchyma, associated with recurrent urinary tract infection. It is seen predominantly in females with no age specificity. The most common symptoms are flank or abdominal pain, fever, palpable mass, and gross hematuria. The common laboratory findings are leukocytosis and anemia. Urine cultures most often reveal Escherichia coli and Proteus mirabilis. Computed tomography is the mainstay of diagnostic imaging for xanthogranulomatous pyelonephritis. Histologically, xanthogranulomatous pyelonephritis presents a granulomatous inflammatory infiltrate mainly composed of lymphocytes, plasma cells, foamy histiocytes, and multinucleated giant cells. The differential diagnosis includes clear cell renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia, tuberculosis, and interstitial nephritis. Treatment includes antibiotics and surgery. In this article, we report a case of xanthogranulomatous pyelonephritis in a 38-year-old male patient with recurrent urinary tract infection.
Highlights
Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation of renal parenchyma, first described by Schlagenhaufer in 1916 (1, 2)
Segmental XGP is characterized by segmental involvement, focal disease is mainly cortical, while diffuse XGP largely involves the renal parenchyma (3)
XGP is characterized by an infectious phlegmon arising in the renal parenchyma, in immunocompromised person with associated urinary tract infection and/or urolithiasis
Summary
Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation of renal parenchyma, first described by Schlagenhaufer in 1916 (1, 2). Segmental XGP is characterized by segmental involvement, focal disease is mainly cortical, while diffuse XGP largely involves the renal parenchyma (3). XGP is characterized by an infectious phlegmon arising in the renal parenchyma, in immunocompromised person with associated urinary tract infection and/or urolithiasis. The clinical presentation is nonspecific, which leads to difficulty in diagnosis with other kidney diseases. We report a case of XGP in a 38-year-old male patient with recurrent urinary tract infection. A 38-year-old male patient presented to the surgical clinic with history of high-grade fever associated with chills and acute severe pain in the left flank for 2 days. Based on the clinical features and radiographic findings, a provisional diagnosis of XGP of the left kidney was made.
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