SHM Converge Scientific Abstract ePoster Gallery-Xanthogranulomatous Pyelonephritis:an Unusual Case of Liver, Colon, and Kidney Abscess

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This case report describes a 41-year-old woman with a history of nephrolithiasis who presented with four months of worsening right flank and right upper quadrant pain, major weight loss, decreased appetite, and dyspnea on exertion. On exam, she was tachycardic, in distress, and had right costovertebral angle tenderness and a palpable liver. Labs showed severe anemia, thrombocytosis, and mild leukocytosis.  <br /><br />CT imaging revealed a right staghorn calculus with a large abscess in the right kidney extending into the right colon and connecting to a hepatic abscess. She was treated initially with piperacillin-tazobactam, followed by aspiration and drainage of the liver abscess. Cultures from both fluid and urine grew heavy Escherichia coli. She was discharged on a four-week course of levofloxacin with the drain in place, and a nuclear medicine study showed the right kidney was nonfunctioning, so right nephrectomy was planned.  <br /><br />The discussion highlights xanthogranulomatous pyelonephritis (XGP), a rare, destructive form of chronic pyelonephritis that accounts for less than 1% of cases. XGP can extend beyond the kidney and involve adjacent organs such as the colon or liver, producing extensive abscesses. Because the condition can be difficult to recognize clinically, imaging is essential for diagnosis.  <br /><br />The authors conclude that XGP should be considered in patients with complex renal infections, especially when abscesses involve both the genitourinary and gastrointestinal systems. Prompt antibiotics, drainage, and surgical removal of the affected kidney are key to preventing permanent complications, including loss of renal function.

Asset Subtitle

Eunbee Cho

Meta Tag

Author List Andres Suarez, Eunbee Cho, Roy Kondapavuluru, Sabhi Gull, Shreel Patel, Sreejith Pillai

Category Clinical Vignettes

Concept Xanthogranulomatous Pyelonephritis

Concept Staghorn Calculus

Concept Nonfunctioning Kidney

Concept Chronic Pyelonephritis

Concept Post-renal Obstruction

Distinguished Non-Finalist

Presenter Organization UTRGV Knapp Medical Center

Presenting Author Eunbee Cho

Track Adult

Keywords

xanthogranulomatous pyelonephritis

staghorn calculus

renal abscess

hepatic abscess

Escherichia coli

nephrectomy

chronic pyelonephritis

kidney infection

flank pain

imaging diagnosis

Xanthogranulomatous Pyelonephritis

Staghorn Calculus

Nonfunctioning Kidney

Chronic Pyelonephritis

Post-renal Obstruction