La pyélonéphrite xanthogranulomateuse

Abstract

Mrs LF 46 years old, with no particular history. She presented with left lower back pain. Clinically she was febrile at 38.8°C, dipstick urinalysi (nitrites, leukocytes +). Physical examination revealed pain during palpation over the left lumbar region. Laboratory tests objectified leukocytosis 22400/mm³, C-reactive protein (CRP) levels of 124 mg/l, and urinalysis test revealed multiple-antibiotic-resistant Escherichia Coli infection in the urine. Radiologically, abdominal ultrasound highlighted a significant left pelvicalyceal dilation with finely echogenic content and reduced cortical index. The CT urography showed increased left kidney size, seat of multiple intraparenchymal fluid, pseudo-cystics, heterogeneous and compartmentalized cavities, with major parenchymal atrophy, excretory delay, and significant perirenal fat infiltration associated with lithiasis of the lumbar ureter measuring 12 mm. The scannographic image allowed us to suggest the following diagnosis: diffuse xanthogranulomateuse pyelonephritis (XGP), multicystic kidney with pyonephrosis, kidney tumor necrosis (clear cell carcinoma...). Radical nephrectomy was performed, the diagnosis of XGP was retained after histopathological examination of the surgical specimen.

The Pan African Medical Journal 2016;24