SHM Converge Scientific Abstract ePoster Gallery-A Complicated Case of Xanthogranulomatous Pyelonephritis

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This case report describes a 56-year-old woman with spastic quadriplegia from multiple sclerosis and a neurogenic bladder managed with a chronic suprapubic catheter who developed severe xanthogranulomatous pyelonephritis (XGP). XGP is a rare, destructive form of chronic kidney infection associated with chronic urinary obstruction, often from staghorn calculi, and can lead to replacement of normal renal tissue by inflammatory and lipid-laden cells. It is usually diagnosed by CT imaging, while pathology confirms the diagnosis.<br /><br />The patient presented in septic shock with leukocytosis and lactic acidosis. CT of the abdomen and pelvis showed a multiloculated right renal abscess with a staghorn calculus extending into the retroperitoneum, consistent with XGP. She initially received ceftriaxone, metronidazole, and percutaneous drainage. Abscess cultures grew Proteus mirabilis, a common organism in XGP.<br /><br />Despite treatment, follow-up imaging showed progression with an enlarging retroperitoneal abscess. The infection became further complicated by multidrug-resistant organisms, including Pseudomonas and Achromobacter. Because of poor response to antibiotics and drainage, she ultimately required staged laparotomies, multiple debridements, and finally a right nephrectomy. She was then treated with meropenem and improved.<br /><br />The report emphasizes that early recognition of XGP is important because delayed diagnosis can allow spread to adjacent structures and lead to serious complications such as retroperitoneal abscesses, fistulas, and loss of renal function. In advanced cases, nephrectomy is often the definitive treatment.

Asset Subtitle

Komal Romance

Meta Tag

Author List Avish Nagpal, Komal Romance

Category Clinical Vignettes

Concept Xanthogranulomatous Pyelonephritis

Concept Urinary Obstruction

Concept Nephrolithiasis

Concept Bear Paw Sign

Concept Nephrectomy

Distinguished Non-Finalist

Presenter Organization University of North Dakota, Transitional Year Program

Presenting Author Komal Romance

Track Adult

Keywords

xanthogranulomatous pyelonephritis

XGP

staghorn calculus

renal abscess

retroperitoneal abscess

septic shock

Proteus mirabilis

multidrug-resistant organisms

nephrectomy

multiple sclerosis

Xanthogranulomatous Pyelonephritis

Urinary Obstruction

Nephrolithiasis

Bear Paw Sign

Nephrectomy