An Unusual Presentation of Chronic Granulomatous Pyelonephritis Presenting as an Acute Spontaneous Retroperitoneal Hemorrhage

Abstract

Abstract:Chronic pyelonephritis presenting as retroperitoneal hemorrhage is an unknown complication and to the best of our knowledge there is only one reported case of acute retroperitoneal hemorrhage complicating a Xanthogranulomatous pyelonephritis. We present an atypical case of Xanthogranulomatous pyelonephritis presenting with acute retroperitoneal haemorrhage ending up with nephrectomy.

Nephron-sparing management of Xanthogranulomatous pyelonephritis presenting as spontaneous renal hemorrhage: a case report and literature review

“…During exploration, the kidney was noted to be hydronephrotic with thinned out parenchyma and palpable thickening of the lower pole which warranted nephrectomy. Unlike the previous cases, lipid-laden macrophage aggregates were not seen though further histopathological examination of the mass revealed chronic granulomatous pyelonephritis with dilated vascular channels and no evidence of neoplasia [ 17 ].…”

“…The etiology of SRH is most frequently due to renal neoplasm but has also been known to arise due to vascular disease or infection [ 13 ]. While the infectious etiologies of SRH are known to include emphysematous pyelonephritis, to the best of our knowledge this is only the 5th case in the literature of XGP presenting with Wunderlich syndrome, although this is difficult to assess due to the many different terms applied to the condition [ 14 – 17 ]. SRH may classically present with “Lenk’s triad” (acute flank pain, abdominal tenderness, and symptoms of internal bleeding), but the disease is also known to present similarly to other abdominal conditions such as appendicitis or dissecting abdominal aortic aneurysm [ 13 , 18 ].…”

“…Lastly, Sharma et al, reported a case of a 60 year old male who presented with left sided flank pain, intermittent fever, and weakness for 15 days [ 17 ]. A known diabetic, the patient was anemic (Hgb 9.0) with an elevated white blood cell count (13,500 per mm 3 ).…”