An abnormal presentation of Xanthogranulomatous Pyelonephritis

Xanthogranulomatous Pyelonephritis (XGP) is commonly misdiagnosed as it can mimic several other pathological conditions. Here we report a case of a 55-year-old female with XGP presenting with pneumomediastinum and associated pleural effusions. The patient was successfully managed with exploratory thoracotomy, mediastinal washout, right lung decortication, and open right nephrectomy to achieve source control. Recognition of this novel complication of XGP is essential for accurate diagnosis and appropriate management, and highlights the importance of counseling patients with existing ureteral stents or nephrostomy tubes about the need for periodic exchanges.