Recurrent pelvi-ureteric junction obstruction due to eosinophilic pelvi-ureteritis

Eosinophilic pelvi-ureteritis is an uncommon inflammatory condition characterised by eosinophil infiltration in the urinary tract, which can lead to varied clinical presentations ranging from urinary obstruction to reflux. Here, we report the case of a boy in early childhood initially diagnosed with right-sided pelvi-ureteric junction (PUJ) obstruction (PUJO) presenting as an abdominal lump with gross hydronephrosis. The patient underwent laparoscopic pyeloplasty over a double-J stent. Postoperatively, the patient exhibited features of recurrent PUJO after stent removal. The patient was taken up for redo-laparoscopic pyeloplasty, and intraoperatively, a polypoidal growth was identified obstructing the PUJ, which, on histopathological analysis, revealed eosinophilic infiltration. Laboratory evaluation showed peripheral eosinophilia. Medical management with corticosteroids, antihistamines and antihelminthics was initiated. At 1-year follow-up, the patient was asymptomatic with preserved renal function. This case highlights eosinophilic pelvi-ureteritis as a rare cause of recurrent PUJO and underscores the importance of a combined surgical and medical approach for effective management.