Xanthogranulomatous Pyelonephritis: A Case Report and Literature Review

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis, often associated with renal calculus and infection <i>Escherichia coli</i> and <i>Proteus mirabilis</i> are the most frequent organisms isolated in individuals with the disease. Its incidence is 1.4 cases per 100,000 population each year. We present a case of a 69-year-old woman who presented with abdominal pain, icterus, fever, non-projectile vomiting, anemia, and recurrent urinary tract infections. A diagnosis of nephrolithiasis was made and the patient was started on empirical antibiotics. An abdominal pelvic CT scan was performed that showed features suggestive of XGP; a nephrectomy was performed, and a tissue biopsy was taken for histopathology and the results confirmed a diagnosis of XGP. XGP diagnosis is extremely challenging due to its ability to mimic other renal pathologies, and a high degree of suspicion is required. Abdominal pelvic ultrasound is helpful in preoperative diagnosis and a biopsy postoperatively is required to confirm XGP diagnosis. Medical management of XGP with antibiotics and nephrectomy is the best treatment option.