Involvement Of Other Organs Research Articles

Different faces of Mycoplasma pneumoniae in children - cardiological and skin complications- case reports and literature review

Mycoplasma pneumoniae is one of the main pathogens responsible for atypical pneumonia, especially in children over the age of 5, where it accounts for about 40% of cases of extramedullary pneumonia. In addition to respiratory-related symptoms, it can lead to a variety of extrapulmonary manifestations associated with involvement of other organs. In this article, we present case reports of two pediatric patients with detected M. pneumoniae infection with associated cardiac and skin complications. The first case report describes an 11.5-year-old boy who was admitted to the Department of Pediatrics because of chest pain, fever and moist cough for several days, who was diagnosed with myocarditis during M. pneumoniae infection. The second case report describes a 17-year-old girl with a recent respiratory infection who was admitted to the hospital for pain, swelling, blistering of the lips and oral mucosa. Mycoplasma pneumoniae infection can lead to extrapulmonary complications in children, which can produce nonspecific symptoms, so clinical vigilance and early recognition are important to minimize the risk of complications.

Relationship of Crohn’s disease and acute pancreatitis in pediatric practice: literature review

Inflammatory bowel diseases (IBD) are a certain group of pathologic conditions of the gastrointestinal tract (GIT), including Crohn’s disease (CD) and ulcerative colitis (UC). In the modern world, vigilance for these diseases is growing, because their characteristic feature is the involvement of other organs in the pathological inflammatory process, as well as the development of local and systemic complications. As a rule, in children CCD occurs mainly at the age of 12-16 years. Recently, the attention of the medical world has been drawn to the issue of extraintestinal manifestations of CD. Pathological manifestations associated with lesions of the skin and mucous membranes, eyes, bone and joint system, pancreas, negatively affect both physical and psychological health of the child. Such pathology associated with pancreatic malfunction, such as acute pancreatitis (AP) often occurs in patients with inflammatory bowel disease and is one of the main causes of hospitalization for diseases of the digestive system. According to statistics, the incidence ranges from 15 to 40 cases per 100,000 per year in European countries. According to the Gastroenterological Society, there are different variations in the course of acute pancreatitis, whether occurring in patients with IBS due to the disease itself or as a side effect of drug therapy. However, IBD patients are at increased risk of developing both acute and chronic pancreatitis. In this review, we consider the relationship and mutual influence of these two pathologies.

Orbital injuries: aspects of forensic medical examination in assessing the severity of harm caused to human health

Background: Forensic examination plays a key role in establishing the severity of injuries, especially of orbital trauma, which can lead to serious consequences, including vision loss. Examination of forensic reports associated with orbital trauma provides valuable information about the nature of the injuries, their prevalence, and factors influencing the severity of the injury. Aim: Analysis of the possibilities of an interdisciplinary approach based on the presence of a full ophthalmological status and computed tomography data of the skull in conducting a forensic medical examination of living persons and in the final qualification of the degree of harm to health in orbital injuries. Materials and methods: An analysis of 37 completed forensic medical examinations of living persons with orbital injuries who were treated in multidisciplinary hospitals in Moscow was carried out. The forensic medical examination was carried out in the Bureau of Forensic Medical Examination of the Moscow Health Department. In 23 cases, the ophthalmological status was assessed at periods from 1 week to 6 months after the injury. In all cases (n = 37; 100%), computed tomography of the facial and cerebral skull was performed. The age of the victims at the time of injury ranged from 12 to 82 years (average 39.7 ± 9.2 years). There were 29 adults among the victims (78.3%), 8 children (21.6%). In terms of gender distribution, there was a significant male predominance — 27 men (73%) versus 10 women (27%). Results: According to the results of the analysis of forensic medical reports, polytrauma with the simultaneous presence of several severe injuries to various organs and systems, combined with orbital trauma, was recorded in 12 victims (32.4%). A combination of traumatic brain injury and orbital injury without involvement of other organs and systems was detected in 9 victims (24.3%), isolated orbital trauma — in 13 people (35.1%), isolated injury of two orbits simultaneously — in 3 victims (8.1%). From the conclusions of forensic experts, it follows that in 89% of cases, the bone walls of the orbits, formed by the frontal, ethmoid and sphenoid bones, as well as the upper jaw, were damaged, which could subsequently lead to damage to the globe, optic nerve and other orbital structures. Damage to the soft tissue of the orbits with globe contusion was noted in 11% of cases. In 3 cases (n = 3; 8.1%), moderate harm to health was determined based on significant persistent loss of general ability to work. In 14 cases (n = 14; 37.8%), it was not possible to focus on the acuteness of the injured globe before the traumatic episode, due to the fact that the victims had no documented visits to an ophthalmologist before the injury. Conclusions: To objectively assess of the orbital trauma and determine the degree of harm to human health, it is necessary to have a full ophthalmological status, including such clinical and instrumental criteria as visual acuteness, presence or absence of ophthalmoplegia and globe dystopia, as well as computed tomography data of the skull, which must be presented in the primary medical documentation.

Anaplastic Plasma Cell Myeloma With Peritoneal Involvement.

Multiple myeloma (MM) is a B-cell neoplasm that rounds 15% of all hematological malignancies. The typical clinical presentation of MM includes hypercalcemia, renal failure, anemia and bone lesion (CRAB). Effusions due to MM may occur due to secondary involvement of other organs and rarely are present at the initial diagnosis. Anaplastic myeloma (AMM) is rare morphological variant of multiple myeloma with predisposition of extramedullary affection. Herein, we describe a case of malignant plasmacytic ascites at disease onset of anaplastic multiple myeloma.

Initial Clinical Presentation of Systematic Lupus Erythematosus (SLE) Patients in Cipto Mangunkusumo Hospital

Background. Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterized by highly diverse and nonspecific symptoms with clinical presentations involving more than one organ system which often leads to delayed diagnosis and poor prognosis. This study aims to understand patients’ initial clinical presentation in order to enhance early detection and establish an early diagnosis. Methods. This descriptive cross-sectional quantitative study included patients who commenced their visits to the Rheumatology Clinic at RSCM from May 2021-December 2022. A consecutive sampling method was used, and data were analyzed for age, gender, symptom onset, as well as patients' initial clinical presentations (SPSS 25.0). Results. Out of 231 subjects, 96.1% were females. A total of 38.1% of the patients belonged to the 21-30 age group, and symptom onset was most commonly observed in the 0-1 year age group, accounting for 67.5%. Approximately 24.2% of the patients exhibited constitutional manifestations with involvement of other organs, including musculoskeletal (87.4%), mucocutaneous (84%), hematologic (3.,5%), renal (33.3%), and neuropsychiatric (8.7%) systems. Lungs, heart, blood vessels, gastrointestinal and hepatic systems, eyes, obstetric, and endocrine involvements were not found in this study. Among the 231 subjects, 44.2% of them had simultaneous involvement of two organs, which emerged as their initial clinical presentation. Conclusion. Musculoskeletal and mucocutaneous involvement were most commonly observed as the initial clinical presentation of SLE patients at RSCM, followed by hematologic, renal, and neuropsychiatric involvement.

Multidisciplinary surgical management of severe posterior compartment endometriosis

BackgroundEndometriosis is a chronic, inflammatory, and hormone-dependent disease that affects approximately 10% of women in reproductive age. Endometriosis is categorized into different types, as superficial, deep, and ovarian endometriosis. When deep endometriosis occurs, the sigmoid and rectum are often affected (Becker et al. in Hum Reprod Open, 2022, https://doi.org/10.1093/hropen/hoac009). In the following article, we aim to demonstrate stepwise surgery for stage IV endometriosis involving the anterior rectosigmoid.MethodsWe present the case of a 26-year-old obese (BMI 35.87) woman with severe posterior pelvic compartment endometriosis, persistent abdominal pain, and constipation. On preoperative MRI of the pelvis, a 13 cm conglomerate incorporating both ovaries (kissing ovaries), uterine serosa, and the anterior rectosigmoid was observed (Fig. 1). Accordingly, interdisciplinary laparoscopic surgery with a gynecologist and colorectal surgeon was planned.ResultsThe total laparoscopic approach is demonstrated step by step in the video.ConclusionsDeep endometriosis is a rare condition. When involvement of other organs (e.g., the bowel) is suspected, preoperative endometriosis-specific imaging should be performed for optimal surgical planning. Experienced endometriosis multidisciplinary surgical teams can provide specialized and high-quality care for patients suffering from this debilitating disease (Luna Russo et al. in Minerva Ginecol, 2020, https://doi.org/10.23736/S0026-4784.20.04544-X).

Clinical manifestations of chronic pancreatitis in English cocker spaniels.

Chronic pancreatitis (CP) is common in English cocker spaniels (ECS). It is histologically similar to IgG4-related disease (IgG4-RD) in humans and is characterized by duct destruction, interlobular fibrosis, and dense periductular and perivenous lymphocytic aggregates. However, the clinical manifestations of CP in ECS have not been previously described. Characterize the clinical manifestations of CP in a group of ECS, including similarities and differences to IgG4-RD in humans. One-hundred four ECS with CP and 44 client owned control ECS without CP (both healthy and diseased controls). Affected dogs were divided into 2 groups according to the methods used to diagnose CP. Case records were searched for signalment, clinical, and clinicopathological findings, and evidence of keratoconjunctivitis sicca (KCS), proteinuria, other immune-mediated diseases, and anal sacculitis. Involvement of other organs was common. Affected ECS presented with a high frequency of KCS (n = 49), proteinuria (n = 47), anal gland disease (n = 36), atopy (n = 21), and other immune-mediated diseases (n = 16). Those with parti-color hair coats, particularly blue roan, had a strong association with CP, suggesting a link between coat color and autoimmune conditions in this breed. English cocker spaniels with CP show clinical similarities to humans with IgG4-RD and common involvement of other organs. Clinicians should evaluate affected Cocker Spaniels for proteinuria, keratoconjunctivitis sicca, and other potential immune-mediated diseases.

Splenic hydatid cyst: a case report

Hydatid cyst (HD) disease is a parasitic infection caused by Echinococcus granulosus. It occurs worldwide, but its prevalence is higher in the rural communities where sheep and cattle raising constitute a crucial component of the agricultural industry. This is a zoonotic disease which spreads via close contact of humans with sheep and dogs. The most common organs involved in hydatid cyst are the liver and lungs. However, other organs may also foster it, such as the spleen which is a rare clinical condition, with an incidence rate of between 0.5% and 4%. In this study, a 46-year-old male with a primary splenic HC is reported with chief complaint of pain and non-tender palpable mass in left hypochondrium. A 9.7×10.6×11 cm splenic cystic mass was detected on ultrasonography (US) and confirmed by abdominal computed tomography (CT) scan, without involvement of other organs. Splenectomy was done along with excision of intact hydatid cyst. Pathological examinations revealed cystic hydatidosis. We describe this case of an isolated splenic HC, which was successfully treated with total splenectomy, focusing on the management and outcome of this disease.

A Study on Neurological Manifestations in Coronavirus Disease 2019 Patients Admitted to a Tertiary Care Hospital.

The coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, the involvement of other organs needs to be explored. Thus, this study is undertaken to analyze the neurological manifestations in patients with COVID-19 infection. To analyze the neurological manifestations in patients with COVID-19 infection. All COVID-19-positive patients who got neurology referrals from March 2020 to June 2021 were included in the study. Laboratory confirmation of COVID-19 infection was done by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of throat swabs in patients who present with symptoms suggestive of COVID-19. Demographic characteristics, neurological complaints, comorbid conditions, neurological examination, and requisite investigations were analyzed. Among 160 patients, 107 (67%) were men, and the mean age was 61 years. Comorbidities included diabetes mellitus (51%) of subjects followed by hypertension (28%), chronic kidney disease (10%), and coronary artery disease (5%). Considering the COVID-19 severity, 28.75% had mild; 8.75% had moderate; and 62.5% had severe disease. The most common neurological symptoms included altered sensorium (62.5%), focal neurological symptoms (29.4%), anosmia (13.1%), headache (10.6%), and seizures (7.5%). The most prevalent neurological signs and/or syndromes were acute encephalopathy (62.5%), stroke (21.3%%), and mucormycosis (12.5%). The mortality rate in our study population was 16.3%, encephalopathy being the most common cause. In our study, encephalopathy was the major cause of morbidity and mortality among the COVID-19-related neurological manifestations. Encephalopathy was most seen in severe COVID-19 infection and was associated with increased neutrophil-to-lymphocyte (NL) ratio raised inflammatory markers. Stroke constituted 29.4% of the neurology referrals in COVID-19 patients confirming COVID-19 infection predisposes to thrombotic events. We found an increased incidence of Mucormycosis in COVID-19 patients, but early debridement and timely treatment with antifungal medications had reduced the mortality.

LAPAROSCHISIS: ABOUT A CASE REPORT AND LITERATURE REVIEW

Laparoschisis is a congenital anomaly characterized by the protrusion of abdominal organs, predominantly the intestines, through a defect in the abdominal wall, typically observed on the right side. It is categorized into simple and complex types based on the extent of the defect and involvement of other organs. The estimated prevalence of laparoschisis is approximately 1 in 10,000 births, with variations noted in different regions. Interestingly, certain areas, like New York and Georgia exhibit an increasing trend, particularly among younger mothers. In Morocco, a study carried out at the Les Orangers hospital in Rabat in 2020 showing that the laparoschisis represent 5.1% of musculoskeletal malformations in newborns (equivalent to 1.7per 10,000 total births). Prenatal ultrasound is the primary diagnostic tool, enabling early detection of the abdominal wall defect and protruding organs. Magnetic resonance imaging (MRI) can provide additional information for diagnosis. Treatment options for laparoschisis include primary repair, performed shortly after birth, and delayed closure, which is postponed for a certain period after birth, depending on case-specific factors such as defect size, condition of protruding organs, and the presence of complications such as stenosis and atresia. Prognosis is influenced by the gravity of the malformation and associated conditions, necessitating close obstetrical and neonatal monitoring with tailored interventions for optimal outcomes. To illustrate the practical aspects of laparoschisis management, we present a case study involving a live-born infant diagnosed with laparoschisis at 34 weeks gestation using prenatal ultrasound. A comprehensive one-stage surgical repair was performed on the newborn. This case highlights the importance of early antenatal diagnosis through ultrasound, potential complications, and immediate and secondary management strategies for optimal outcomes in affected infants.

Case report of leukoencephalopathy with predominant brainstem and spinal cord involvement and lactate elevation behind the mask of multiple sclerosis

Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is a rare or underdiagnosed autosomal-recessive mitochondrial disease that sometimes mimics progressive multiple sclerosis (MS). Difficulties in diagnosing LBSL are due to the possibility of the onset of the disease in adulthood, and the nonspecific clinical picture in the form of slowly progressive neurological symptoms (pyramidal, cerebellar, sensory and cognitive impairments) without the involvement of other organs and systems characteristic of mitochondrial pathology. However, a notable feature of LBSL is its pathognomonic magnetic resonance imaging of the white matter of the brain and spinal cord, which allows a reliable diagnosis when certain criteria are met. Currently, there are no drugs registered for the specific treatment of LBSL, however, correct diagnosis is necessary to complete the epidemiological data, and to prevent the prescription of drugs with side effects that worsen the quality of life of patients. The number of clinical publications about LBSL is small, both in Russian and foreign publications, and therefore each identified case is of great interest. The article presents a brief review of the literature and a case report of a patient with the adult-onset LBSL, who received disease modifying therapy of multiple sclerosis for a long time. The patient’s main problems were progressive lower paraparesis and ataxia. To make clinicians more aware, we have reviewed the difficulties in differential diagnosis between LBSL and MS, we provided detailed medical history, neurological status, and magnetic resonance imaging findings.

Ocular manifestations of rheumatic diseases

Rheumatic diseases are a large group of conditions of various origins, predominantly systemic in nature, with persistent or transient joint syndrome and involvement of other organs and systems, including the eyes. Many rheumatic diseases are characterized by specific types of ocular inflammation, which manifests through its localization, symmetry, and clinical features.

Primary laryngeal histoplasmosis: a case report

BackgroundHistoplasmosis is a fungal infection that commonly occurs in the lungs or in disseminated form. Primary laryngeal histoplasmosis is a very rare condition that can mimic laryngeal carcinoma or laryngeal tuberculosis. The purpose of this case report is to highlight the rare occurrence of primary laryngeal histoplasmosis with no involvement of other organs, especially the lungs, the diagnosis dilemma, and the antifungal protocol for this case.Case presentationWe report a case of a 47-year-old male, who is a pigeon breeder, presented with chronic hoarseness. There were no signs of pulmonary or systemic involvement. Biopsy from laryngeal mucosa was confirmed as histoplasmosis, and he was started on intravenous (IV) amphotericin B for 2 weeks and oral itraconazole for 2 months.ConclusionPrimary laryngeal histoplasmosis is considered a very rare occurrence. The laryngeal lesion may mimic conditions such as laryngeal carcinoma and laryngeal tuberculosis. Histopathology examination remains the gold standard, and antifungal treatment is the choice of therapy.

Langerhans Cell Histiocytosis in the Oral Cavity

Background: Langerhans cell histiocytosis (LCH) is a rare hematological malignancy. The incidence of this disease is only 1% of soft tissue and lymph node cancer. Clinical manifestations and organ involvement vary widely. Lesions in the oral cavity are rare. LCH occurs more often in children, 10 times more often than in young adults.
 Case presentation: A 20-year-old male came with the main complaint of a lump on the roof of the mouth and the right inner cheek. Physical examination of the face and oral cavity found a mass attached to the palate 1x1x1 cm with the same color as the surrounding tissue, flat surface, soft consistency, could be moved, and a mass was found in the left buccal 2x2x2 cm, with the same color as the surrounding tissue, flat surface, cystic consistency, not fixed and can be moved. Hematology laboratory examination was within normal limits, so no examination was carried out for bone marrow puncture (BMP). From the results of a CT scan of the head and neck, a solid mass was found with a hypodense part in it in the right buccal area attached to m. right masseter, and in the left hard palate area, which was suggestive of Langerhans cell histiocytosis. The results of histopathological examination of the lesion which underwent an incisional biopsy showed positive S100 and CD1a, this patient was diagnosed with Langerhans cell histiocytosis LCH. Next, this patient was treated with excision of the mass in the palate and buccal area. The patient was treated in the surgical inpatient department for 2 days, and the postoperative wound was in good condition.
 Conclusion: Cases of Langerhans cell histiocytosis (LCH) are very rare cases that have different clinical symptoms depending on the organs involved, so it is important to understand this disease better. In this case, it was unilocal LCH without the involvement of other organs, so only local therapy was carried out in the form of surgical excision and observation was carried out after 3 months after surgery with the results of the wound improving without any new lumps appearing.

SURGICAL TREATMENT OF FEMORAL SHAFT FRACTURES IN POLYTRAUMATIZED PATIENTS

Fractures of the femur are common, usually serious and are the result of high-energyaccidents. They can be associated with involvement of other organs, causing deformities and sequelae for the patient, due to immediate or late complications. Anatomical reduction and stable internal fixation are essential in order to achieve the treatment objectives in patients with good bone quality. Treatment is eminently surgical as it allows early rehabilitation and reduces the risk of systemic complications. There are numerous therapeutic options, but osteosynthesis with an intramedullary plate and nail stands out. However, some factors influence the choice of the type of surgical intervention to be performed, such as hospital resources, availability of suitable material for the procedure, trained staff and availability of an image intensifier.

Magnetic resonance imaging for diagnosing a rare disease: incontinentia pigmenti (Bloch–Sulzberger syndrome) on the example of a clinical case

Incontinentia pigmenti, also known as BlochSulzberger syndrome, is a rare hereditary disease characterized by typical skin rashes and involvement of other organs and systems. Magnetic resonance imaging stands as the primary method for visualizing the structural pathology of the brain and predicting neurological manifestations in an affected child.
 Diagnosing incontinentia pigmenti predominantly falls within the domain of dermatologists; verification is performed by molecular genetic analysis of the IKBKG gene. This study involved magnetic resonance imaging of the brain in a patient with skin rashes, characteristic of BlochSulzberger syndrome, and deletion in the IKBKG gene, where numerous foci of ischemia, hemorrhages, and lesions of the tracts were detected.
 Magnetic resonance imaging of the brain in patients with BlochSulzberger syndrome is used to evaluate the severity of damage to the brain substance, which makes it possible to explain the cause of neurological symptoms and correct habilitation, as well as predict the development of the child.

Dietary methylmercury and fatty acids affect the lipid metabolism of adipose tissue and liver in rainbow trout

Methylmercury (MeHg) is a pervasive environmental contaminant in aquatic ecosystems that can reach elevated concentrations in fish of high trophic levels, such as salmonids. The present study aims at investigating the individual and combined impacts of dietary MeHg and fatty acids on lipid metabolism in juvenile rainbow trout (Oncorhynchus mykiss) with a focus on two key organs, adipose tissue and liver. MeHg and fatty acids are both known to act on energy homeostasis although little is known about their interplay on lipid metabolism in fish. Fish were fed diets enriched in linoleic acid (LA, 18:2 n-6), α-linolenic acid (ALA, 18:3 n-3), eicosapentaenoic acid (EPA, 20:5 n-3) or docosahexaenoic acid (DHA, 22:6 n-3) for ten weeks, with the addition of MeHg to the diets during the last six weeks (0, 2.4 or 5.5 mg MeHg/kg dry matter). LA and ALA are polyunsaturated fatty acids (PUFA) typical of plant-derived oils whereas EPA and DHA are n-3 long chain PUFA largely found in fish oil, all used in feed formulation in aquaculture. The results showed that the LA-enriched diet induced a higher whole-body lipid content compared to the three other diets. On the contrary, the addition of MeHg led to a significant reduction of the whole-body lipid content, regardless of the diet. Interestingly, the adipocytes were larger both in presence of LA, compared to EPA and DHA, or MeHg, indicating a lipogenic effect of these two compounds. No effect was, however, observed on lipid accumulation per gram of adipose tissue. The fatty acid composition of adipose tissue and liver was significantly modified by the dietary lipids, reflecting both the fatty acid composition of the diets and the high bioconversion capacity of the rainbow trout. Exposure to MeHg selectively led to a release of n-6 PUFA from the hepatic membranes of fish fed the LA-enriched diet, showing a disruption of the pathways using n-6 PUFA. This study highlights the significant impact of MeHg exposure and dietary fatty acids on lipid metabolism in fish. Further investigation is needed to elucidate the underlying mechanisms and to explore the potential involvement of other organs.

PAX2 Gene Mutation in Pediatric Renal Disorders-A Narrative Review.

The PAX2 gene is a transcription factor that is essential for the development of the urinary system among other transcription factors. The role of PAX2 is highlighted from the seventh week of gestation, when it is involved in development processes and the emergence of nephrons and collecting tubes. Being an important factor in renal development, mutations of this gene can produce severe alterations in the development of the urinary tract, namely congenital anomalies of the kidneys and urinary tract. The first reported cases described with the PAX2 mutation included both renal anomalies and the involvement of other organs, such as the eyes, producing renal coloboma syndrome. Over the years, numerous cases have been reported, including those with only renal and urinary tract anomalies. The aim of this review is to present a summary of pediatric patients described to have mutations in the PAX2 gene to contribute to a better understanding of the genetic mechanism causing anomalies of the kidneys and urinary tract. In this review, we have included only pediatric cases with renal and urinary tract disorders, without the involvement of other organs. From what we know so far from the literature, this is the first review gathering pediatric patients presenting the PAX2 mutation who have been diagnosed exclusively with renal and urinary tract disorders.

Platelet genetic testing by next-generation sequencing: A practical update.

Inherited platelet disorders (IPDs) are a heterogeneous group of disorders characterized by normal or reduced platelet counts, bleeding diatheses of varying severities, and the presence (syndromic) or absence (non-syndromic) of involvement of other organs. Due to the lack of highly specific platelet function tests and overlapping clinical and laboratory features, diagnosing the underlying cause of IPDs remains challenging. In recent years, genetic testing via next-generation sequencing (NGS) technologies to rapidly analyze multiple genes has gradually emerged as an important part of the laboratory investigation of patients with IPDs. A systemic clinical and laboratory testing approach and thorough phenotype and genotype correlation studies of both patients and their family members are crucial for accurate diagnoses of IPDs.

DUBIOUS APPENDICITIS TO BE ACCOMPANIED BY RIGHT XANTHOGRANULOMATOUS PYELONEPHRITIS: A CASE REPORT

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic kidney infection that can cause a progressive decline in kidney function and lead to kidney removal or death. Symptoms of right flank pain due to XGP, sometimes radiating to the lower abdomen were difficult to assess and distinguish from urinary tract diseases alone or accompanied by the involvement of other organs like appendicitis. We report a fifty-year-old woman was referred because of a suspected mass in the right kidney based on ultrasound, but the results of the Ct-Scan with contrast showed stones and chronic parenchymal kidney with a tendency to right pyelonephritis. There were no post-contrast enhancing masses in both kidneys. Then, decided to perform a nephroureterectomy and found inflammation in her appendices. Histopathology showed xanthogranulomatous pyelonephritis and chronic appendicitis. The patient was diagnosed with Chronic pyelonephritis based on CT-Scan, but the previous ultrasound showed no appendicitis, there was a mass in the right kidney. During nephroureterectomy, there were chronic appendicitis and Xanthogranulomatous Pyelonephritis after histopathology examination. This report describes uncommon pyelonephritis and confirms the difficulty of differentiating right XGP from appendicitis, even though it occurred in a large city. Moreover, it can be a lesson for general practitioners to be more thorough in diagnosing right abdominal or flank pain.