Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2020.200
Autopsy and Case Reports
Clinical Case Report

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

Manpreet Singh; Dillibabu Ethiraj; Venkatraman Indiran; Niranjan Dhanaji Kanase; Prabakaran Maduraimuthu

Downloads: 0
Views: 228

Abstract

ABSTRACT: Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of “Bear Paw Sign.” An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

Keywords

Pyelonephritis, Xanthogranulomatous, Urinary Tract Infections, Escherichia coli

References

1 Friedl A, Tuerk C, Schima W, Broessner C. Xanthogranulomatous pyelonephritis with staghorn calculus, acute gangrenous appendicitis and enterocolitis: a multidisciplinary challenge of kidney-preserving conservative therapy. Curr Urol. 2015;8(3):162-5. http://dx.doi.org/10.1159/000365709. PMid:26889137.

2 Lintong PM, Durry M. Xanthogranulomatous pyelonephritis. MOJ Clin Med Case Rep. 2015;2(2):36-8.

3 Li L, Parwani AV. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med. 2011;135(5):671-4. PMid:21526966.

4 Lee JH, Kim SS, Kim DS. Xanthogranulomatous pyelonephritis: “bear’s paw sign. J Belg Soc Radiol. 2019;103(1):31. http://dx.doi.org/10.5334/jbsr.1807. PMid:31139769.

5 Chow J, Kabani R, Lithgow K, Sarna MA. Xanthogranulomatous pyelonephritis presenting as acute pleuritic chest pain: a case report. J Med Case Reports. 2017;11(1):101. http://dx.doi.org/10.1186/s13256-017-1277-4. PMid:28399929.

6 Kundu R, Baliyan A, Dhingra H, Bhalla V, Punia RS. Clinicopathological spectrum of xanthogranulomatous pyelonephritis. Indian J Nephrol. 2019;29(2):111-5. PMid:30983751.

7 Chandanwale SS. Xanthogranulomatous pyelonephritis: Unusual clinical presentation: a case report with literature review. J Family Med Prim Care. 2013;2(4):396-8. http://dx.doi.org/10.4103/2249-4863.123942. PMid:26664851.

8 Barral M, Sánchez Crespo JM, Pérez Herrera JC, Ortega Garcia JL, Hidalgo Ramos FJ, Porcuna Cazalla G. Xanthogranulomatous pyelonephritis: radiologic review. In: ECR 2014 Congress; 2014; Vienna. Vienna: European Society of Radiology; 2014. http://dx.doi.org/10.1594/ecr2014/C-0557.

9 Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28(1):255-77. http://dx.doi.org/10.1148/rg.281075171. PMid:18203942.

10 Kempegowda P, Eshwarappa M, Dosegowda R, Aprameya IV, Khan MW, Kumar PS. Clinico-microbiological profile of urinary tract infection in south India. Indian J Nephrol. 2011;21(1):30-6. http://dx.doi.org/10.4103/0971-4065.75226. PMid:21655167.

11 Leoni FA, Kinleiner P, Revol M, Zaya A, Odicio A. Xanthogranulomatous pyelonephritis: review of 10 cases. Arch Esp Urol. 2009;62(4):259-71. http://dx.doi.org/10.4321/S0004-06142009000400001. PMid:19717876.

12 Ghoz HM, Williams M, Perepletchikov A, James N, Babeir AA. An unusual presentation of xanthogranulomatous pyelonephritis: psoas abscess with reno-colic fistula. Oxf Med Case Rep. 2016;(7):150-3. http://dx.doi.org/10.1093/omcr/omw063. PMid:27471599.
 


Submitted date:
04/29/2020

Accepted date:
06/19/2020

Publication date:
12/08/2020

5fcfb8250e8825946e4ac228 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections