Xanthogranulomatous pyelonephritis: Intrahepatic and intrathoracic extension

Abstract

A 32-year-old female presented to us with worsening cough and expectoration, low-grade fever, and malaise for 3 months. She gave a history of pregnancy loss secondary to urinary tract infection (UTI) a year back. At that time, she was told to have an obstructive right renal calculus. She also had a history of recurrent UTI in the past 1 year. She had no other comorbidities. Her clinical evaluation revealed an enlarged right kidney and reduced air entry in the right hemithorax. Radiological investigations revealed a large right kidney invading into the inferior surface of the right lobe of the liver and the right pleural space. A clinical diagnosis of xanthogranulomatous pyelonephritis was made, and she was advised nephrectomy. Intraoperatively, the right kidney was found to invade both the right lobe of the liver and the right pleural cavity through a right diaphragmatic defect. Histopathology of the kidney revealed the presence of foamy histiocytes suggestive of xanthogranulomatous pyelonephritis. Invasive xanthogranulomatous pyelonephritis is known, however, invasion into the extra-abdominal structures has not been reported in the literature. Our case is a rare manifestation of a rare clinical entity – xanthogranulomatous pyelonephritis.

Metastatic xanthogranulomatous pyelonephritis managed with immunosuppression

“…Extra‐abdominal spread of disease has been described but is far rarer. In these cases, intra‐thoracic spread was noted incidentally on CT imaging and did not require treatment beyond nephrectomy 6,7 . En‐bloc nephrectomy is the mainstay of treatment for unilateral xanthogranulomatous pyelonephritis or partial nephrectomy in the case of bilateral disease 8 .…”

Lung abscess with chronic cough secondary to xanthogranulomatous pyelonephritis: A rare case report

“…[8] Although laparoscopic nephrectomy is more challenging, it has been reported to be safe in patients with XGPN, although the conversion rate is high in difficult cases. [9] Unusual clinical presentations described in case reports include acute peritonitis, ischemic colitis, sciatica, empyema, and nephrobronchial fistula, [10][11][12][13][14] XGPN with transdiaphragmatic extension through erosion is rare. [15] Identical bacterial species with the same drug spectrum from both nephrostomy urine and sputum cultures supported our findings.…”

“…Unusual clinical presentations described in case reports include acute peritonitis, ischemic colitis, sciatica, empyema, and nephrobronchial fistula, [10–14] XGPN with transdiaphragmatic extension through erosion is rare. [15] Identical bacterial species with the same drug spectrum from both nephrostomy urine and sputum cultures supported our findings.…”

Xanthogranulomatous Pyelonephritis: Synchronous Upper and Lower Gastrointestinal Bleed

“…Fistulas connecting the kidney to the colon, jejunum, duodenum, bronchus, diaphragm, thorax, psoas muscle, and skin were reported. 4-12…”

“…Fistulas connecting the kidney to the colon, jejunum, duodenum, bronchus, diaphragm, thorax, psoas muscle, and skin were reported. [4][5][6][7][8][9][10][11][12] There are no reported cases of concurrent reno-gastric and reno-colic fistulas. Herein, we describe a unique case of reno-gastric and reno-colic fistulas in a patient with history of left renal calculus presenting with simultaneous upper and lower gastrointestinal bleed.…”