Presentation
Patient presented with symptoms of colitis and a history of recurrent urinary tract infections cultured as Escherichia coli (then later as Pseudomonas aeruginosa)
Patient Data
There is a staghorn calculus of the left renal pelvis and further extensive calculi within the dilated calyces, with thinning of the renal parenchyma in keeping with xanthogranulomatous pyelonephritis. Left perinephric and para-aortic lymphadenopathy. There is thickening of the proximal left ureter with periureteric fat stranding, likely to represent pyelitis/urethritis. The right kidney is within normal limits with a simple cortical cyst.
Sigmoid colitis/proctitis.
Bilateral pleural effusions and bibasal collapse/consolidation.
Renal calculi and also ulcerative colitis flare.
Case Discussion
Xanthogranulomatous pyelonephritis is a form of pyelonephritis and is a chronic inflammatory condition that is caused by infection of the kidney, usually as a secondary complication to staghorn calculi. The differential must include renal carcinomas, malakoplakia, megalocytic interstitial nephritis and perhaps leiomyosarcoma.