Xanthogranulomatous pyelonephritis presenting as emphysematous pyelonephritis: a rare association.
SV Punekar, JS Kinne, SR Rao, C Madiwale, SS Karhadkar
Department of Urology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, India., India
S V Punekar
Department of Urology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, India.
Xanthogranulomatous and emphysematous pyelonephritis are two rare variants of pyelonephritis. Their combined occurrence is a very rare condition, which has been documented in our case.
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Punekar S V, Kinne J S, Rao S R, Madiwale C, Karhadkar S S. Xanthogranulomatous pyelonephritis presenting as emphysematous pyelonephritis: a rare association. J Postgrad Med 1999;45:125-125
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Punekar S V, Kinne J S, Rao S R, Madiwale C, Karhadkar S S. Xanthogranulomatous pyelonephritis presenting as emphysematous pyelonephritis: a rare association. J Postgrad Med [serial online] 1999 [cited 2021 Jan 21 ];45:125-125
Available from: https://www.jpgmonline.com/text.asp?1999/45/4/125/331
Xanthogranulomatous pyelonephritis is a chronic suppurative renal infection usually superimposed on obstruction of pelvicalyceal system. Rarely, emphysematous pyelonephritis can complicate xanthogranulomatous pyelonephritis thus further making diagnosis difficult.
A seventy-year-old female, a known diabetic presented with left loin pain and fever with chills of seven days duration. Urine examination showed plenty of pus cells and grew Klebsiella on culture. Serum creatinine was 4.1 mg %. A computed tomographic scan confirmed the diagnosis of left emphysematous pyelonephritis and ruled out an associated urinary tract obstruction and showed patchy uptake of contrast by the left kidney.
A medical line of management with third generation cephalosporins and control of diabetes improved the general condition of the patient Although the renal chemistry returned to normal, the persistence of gas on X-Ray and increasing insulin requirements lead to a left flank exploration. The left kidney was of normal size, soft and jelly-like in consistency and dirty yellow in color. A left nephrectomy was performed. Post-operative recovery was uneventful. Histopathological examination revealed xanthogranulomatous pyelonephritis.
Emphysematous pyelonephritis is a rare, acute suppurative parenchymal and perirenal infection common in elderly diabetic females. E. coli and Klebsiella are the common causative organisms. Xanthogranulomatous pyelonephritis is a rare, chronic renal infection common in middle age diabetic females E. coli and Proteus are the commonly implicated organisms. In spite of common etiological and pre-disposing factors, only four cases of combined xanthogranulomatous and emphysematous pyelo-nephritis have been reported in the world literature,,. We report this case for its rarity.
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