Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous Pyelonephritis Presenting as a Psoas Abscess

“…The clinical presentation of iliopsoas abscess is often variable and non-specific, the classical clinical triad consisting of fever, back pain, and limp is present in only 30% of the patients [6]. Although our patient presented two of these classic symptoms of iliopsoas abscess, unlike the cases described in the literature of XGP with psoas abscess the majority had most of the typical presenting symptoms of XGP [2,3,7,8].…”

“…However, with the decreasing prevalence of tuberculosis, iliopsoas abscess has become uncommon, and Crohn's disease is the commonest cause of secondary iliopsoas abscess [3,6]. In addition, psoas abscess secondary to XGP is uncommon, and just a few cases are described in the literature [2,3,7,8]. The clinical presentation of iliopsoas abscess is often variable and non-specific, the classical clinical triad consisting of fever, back pain, and limp is present in only 30% of the patients [6].…”

“…The definitive diagnosis of XGP is made by renal biopsy [1,7]. With or without adjunctive antibiotic therapy, nephrectomy has been the preferred treatment for XGP and is curative [1][2][3][4][5].…”

“…Xanthogranulomatous pyelonephritis (XGP) was first described by Schlagenhaufer in 1916 and remains a rare disease with an annual incidence of 1.4 per 100,000 inhabitants [1][2][3]. XGP is an unusual variant of chronic pyelonephritis, characterized by progressive parenchymal destruction.…”

“…Para-renal tissue involvement is uncommon although some cases of psoas abscess have been reported [2,3,7,8]. Abdominal computed tomography scanning is the gold standard diagnostic method [1,2,4]. Most cases require a total nephrectomy to resolve symptoms [1,4,5].…”