Xanthogranulomatous pyelonephritis infected with the Providencia stuartii: a case report and literature review

Abstract

Background Xanthogranulomatous pyelonephritis (XGP) is a rare and severe chronic inflammatory disease of the renal parenchyma, which is most commonly associated with super-infections by bacteria such as E. coli, Proteus mirabilis, and occasionally Pseudomonas species. Case presentation Herein, we present a rare case of a patient with XGP infected with Providencia stuartii. Initially, the patient refused nephrectomy and underwent holmium laser lithotripsy and right ureteral stenting, followed by meropenem treatment of 7 days. Relapse occurred in the third month after discharge from the hospital, due to which she underwent a radical nephrectomy. Discussion The diagnosis of XGP is confirmed by histopathology. The standard treatment for XGP is antibiotic therapy and radical nephrectomy, but partial nephrectomy may be appropriate in select cases.

Xanthogranulomatous pyelonephritis as a complication of recurrent urinary tract infection

“…On his follow-up after completion of antibiotic therapy, he reported total resolution of his symptoms, and an elective right nephrectomy was planned after counselling. XGP is a rare severe chronic inflammatory disease of the renal parenchyma, which is characterised by the destruction of the renal parenchyma and granulomatous inflammation, with lipid-laden foamy macrophages as well as inflammatory infiltration and extensive renal fibrosis 1. Although the aetiology of XGP remains unclear, it is commonly associated with recurrent UTIs and obstructive nephropathy.…”

“…XGP might occur in all age groups, but predominantly affects adults. XGP often occurs unilaterally, and bilateral cases are extremely rare, mostly diffuse and occupationally focal 1. Typical clinical manifestations of XGP are fever of unknown origin, abdomen/flank pain, weight loss, anaemia or palpable renal mass 1.…”

“…XGP often occurs unilaterally, and bilateral cases are extremely rare, mostly diffuse and occupationally focal 1. Typical clinical manifestations of XGP are fever of unknown origin, abdomen/flank pain, weight loss, anaemia or palpable renal mass 1. Commonly isolated pathogenic bacteria are Escherichia coli , Klebsiella and Proteus .…”

“…Depending on the extent of inflammation, XGP can be classified into three stages: nephric XGP (stage I: confined localised disease to the renal parenchyma), perinephric XGP (stage II: the inflammation extends to the perirenal fat) and perinephric XGP (stage III: the lesion extending into perinephric spaces) 4 5. The standard management is antibiotic therapy and total nephrectomy, but focal XGP can be treated with antibiotics or nephron-sparing surgery 1 3…”

“…XGP is a rare severe chronic inflammatory disease of the renal parenchyma, which is characterised by the destruction of the renal parenchyma and granulomatous inflammation, with lipid-laden foamy macrophages as well as inflammatory infiltration and extensive renal fibrosis. 1 Although the aetiology of XGP remains unclear, it is commonly associated with recurrent UTIs and obstructive nephropathy. Other proposed aetiologies include altered immune response, congenital urinary anomalies, lipid metabolism abnormalities, malnutrition and lymphatic blockage.…”