SHM Converge Scientific Abstract ePoster Gallery-Hepatic Abscesses as a Complication of Xanthogranulomatous Pyelonephritis

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This case report describes a rare complication of xanthogranulomatous pyelonephritis (XGP), a destructive chronic kidney infection usually associated with recurrent kidney stones. XGP can mimic malignancy and may spread beyond the kidney, making early recognition important because nephrectomy is often required.<br /><br />A 58-year-old woman with multiple sclerosis, neurogenic bladder with an indwelling catheter, and recurrent nephrolithiasis presented with malaise and dizziness. She had leukocytosis, severe anemia, pyuria, and calcium oxalate crystals in her urine. CT imaging showed bladder and right renal calculi, along with large communicating hepatic abscesses. The right kidney demonstrated the classic “bear paw” sign, supporting the diagnosis of XGP.<br /><br />The hepatic abscesses were drained, yielding 700 cc, and follow-up imaging showed near complete resolution. Cultures grew Streptococcus anginosus and Bacteroides fragilis. She was treated with two weeks of levofloxacin and metronidazole and was scheduled for nephrectomy, cystolithotomy, and suprapubic catheter placement.<br /><br />The discussion emphasizes that XGP is most often seen in women with chronic obstructive nephrolithiasis and may present with fever, malaise, flank pain, anemia, and abnormal urinalysis. It is typically unilateral and caused by gram-negative organisms, though cultures may be negative. Because it can resemble renal cancer or other inflammatory conditions, imaging and clinical context are essential for diagnosis.<br /><br />Hepatic extension of XGP is rare but should be considered in patients with chronic stone disease and liver abscesses. Management of cases with extrarenal spread includes drainage, nephrectomy, and closure of any fistulas.

Asset Subtitle

Matthew Balatbat

Meta Tag

Author List Bijal Mehta, Matthew Balatbat, Roveena Goveas, Vishal Ramjas

Category Clinical Vignettes

Concept Xanthogranulomatous Pyelonephritis

Concept Bear Paw Sign

Concept Nephrectomy

Concept Nephrolithiasis

Concept Leukocytosis

Distinguished Non-Finalist

Presenter Organization Hackensack Meridian Mountainside Medical Center

Presenting Author Matthew Balatbat

Track Adult

Keywords

xanthogranulomatous pyelonephritis

XGP

hepatic abscess

renal calculi

nephrolithiasis

bear paw sign

nephrectomy

Streptococcus anginosus

Bacteroides fragilis

extrarenal spread

Xanthogranulomatous Pyelonephritis

Bear Paw Sign

Nephrectomy

Nephrolithiasis

Leukocytosis