RESUMO
BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is a rare and severe chronic inflammatory disease of the renal parenchyma, which is most commonly associated with super-infections by bacteria such as E. coli, Proteus mirabilis, and occasionally Pseudomonas species. CASE PRESENTATION: Herein, we present a rare case of a patient with XGP infected with Providencia stuartii. Initially, the patient refused nephrectomy and underwent holmium laser lithotripsy and right ureteral stenting, followed by meropenem treatment of 7 days. Relapse occurred in the third month after discharge from the hospital, due to which she underwent a radical nephrectomy. DISCUSSION: The diagnosis of XGP is confirmed by histopathology. The standard treatment for XGP is antibiotic therapy and radical nephrectomy, but partial nephrectomy may be appropriate in select cases.
Assuntos
Infecções por Enterobacteriaceae , Providencia , Pielonefrite Xantogranulomatosa/microbiologia , Adulto , Feminino , HumanosRESUMO
BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of the kidney and its treatment most often involves a combination of antibiotics and nephrectomy. This study aimed to define the clinical features and management of XGP, focusing on microbiological aspects and antibiotic therapy. METHODS: We performed a retrospective study of 27 cases of XGP diagnosed between January 2001 and January 2020 to analyse their clinical and management characteristics. In addition, a literature review was conducted of XGP case series covering the period from 2000-2020. We searched PubMed for case series through April 2020 without language restrictions. Studies reporting case series of XGP (more than ten cases) were included if they were relevant to this study. RESULTS: Twenty-seven patients were diagnosed with XGP, and 26 of them were histologically proven to have XGP. A total of 81.5% of the patients were female and the mean age was 59.6 years (SD 19.2). The most frequent symptoms were flank pain (70.4%) and fever (59.3%), while 77.8% of patients had renal stones. Proteus mirabilis was detected in the urine culture in 18.5% of patients, followed by detection of Escherichia coli in 14.8% of patients. The computed tomography (CT) findings included perirenal (29.6%) or pararenal (29.6%) involvement in the majority of patients. Twenty-six patients underwent nephrectomy. Piperacillin/tazobactam and ceftriaxone were the most commonly prescribed antibiotics for treatment. The reported piperacillin/tazobactam and ceftriaxone resistance rates were 14.3% and 16.6%, respectively. Twenty-six case series were included in the literature review, reporting 693 cases in total. CONCLUSION: We found well-established characteristics of XGP patients among series in terms of previous history, clinical, laboratory and imaging findings, and operative and postoperative outcomes. It is important to know the clinical presentation and potential severity of XGP, as well as the most frequently involved microorganisms and their antibiotic resistance profiles, to select the most appropriate antibiotic therapy.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Farmacorresistência Bacteriana , Pielonefrite Xantogranulomatosa/tratamento farmacológico , Pielonefrite Xantogranulomatosa/microbiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We report a case of an immunosuppressed 67-year-old woman who presented with fever of unknown origin. Further investigation revealed multiple left renal and perinephric abscesses. These were managed with percutaneous drainage and broad-spectrum antibiotics; however, no clinical improvement resulted. No organism was identifiable on standard microscopy and culture of all drain, blood and urine samples taken. Left nephrectomy with right urinary diversion was performed for sepsis management and to protect the patient's right kidney. Eventually, Ureaplasma species' RNA was detected in the patient's drain fluid using PCR and 16S ribosomal RNA gene sequencing. The patient was treated successfully with targeted antibiotic therapy and underwent extensive rehabilitation following this. Histopathology of the nephrectomy specimen suggested xanthogranulomatous pyelonephritis.
Assuntos
Abscesso/microbiologia , Abscesso/terapia , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/terapia , Infecções por Ureaplasma/microbiologia , Infecções por Ureaplasma/terapia , Abscesso/diagnóstico por imagem , Idoso , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Nefrectomia , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Infecções por Ureaplasma/diagnóstico por imagem , Ureaplasma urealyticum/efeitos dos fármacosRESUMO
BACKGROUND: Xanthogranulomatous pyelonephritis is a rare and serious manifestation of chronic kidney inflammation that can be life-threatening if not recognized and treated appropriately, often with antibiotics and surgery. Affected patients are most commonly females in their fifth or sixth decade of life with a background of obstructive uropathy, nephrolithiasis, or recurrent urinary tract infections who present with vague nonspecific symptoms. CASE PRESENTATION: A 43-year-old woman of Russian ethnicity with a history of nephrolithiasis presented to our emergency department with new left-sided pleuritic chest pain amid a 6-week history of constitutional symptoms including fevers, night sweats, and 7 kg of weight loss. Workup for acute coronary syndrome and pulmonary embolism in our emergency department was negative. Given that she was clinically unwell, she was admitted to internal medicine to expedite workup for the cause of her symptoms. A broad differential diagnosis for various infectious, inflammatory/autoimmune, and neoplastic processes was considered. Based on classic radiographic and histopathologic findings, she was ultimately diagnosed with xanthogranulomatous pyelonephritis of her left kidney, which was a direct consequence of chronic inflammation. This inflammation exhibited spread to local tissues and across her left hemidiaphragm, resulting in a unilateral pleural effusion which explained her chest discomfort. She was treated with antibiotics administered intravenously and urgent total nephrectomy with a good functional outcome. CONCLUSIONS: Our case illustrates an uncommon but clinically important do-not-miss diagnosis that underlies a common clinical presentation of pleuritic chest pain. The case underscores the importance of maintaining a broad differential diagnosis and organized approach when treating patients with undifferentiated clinical presentations.
Assuntos
Antibacterianos/administração & dosagem , Dor no Peito/etiologia , Nefrectomia , Nefrolitíase/complicações , Derrame Pleural/diagnóstico , Pielonefrite Xantogranulomatosa/diagnóstico , Administração Intravenosa , Adulto , Feminino , Febre/etiologia , Humanos , Nefrolitíase/microbiologia , Nefrolitíase/fisiopatologia , Derrame Pleural/microbiologia , Derrame Pleural/terapia , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/terapia , Resultado do Tratamento , Redução de PesoRESUMO
Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis observed in only a few cases in children. Symptoms are mild, which explains the delay in diagnosis. Diagnosis is based on histology but can be suspected on CT. The treatment is medical and often surgical, with an uncertain renal prognosis. It is therefore imperative to diagnose early. We report the case of a 4-year-old child who presented with xanthogranulomatous pyelonephritis caused by Pseudomonas aeruginosa, which evolved into pyonephrosis, due to inadequate antibiotic therapy. This highlights the importance of understanding this disease and not treating urinary tract infections blindly.
Assuntos
Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa , Pielonefrite Xantogranulomatosa/complicações , Pionefrose/etiologia , Pré-Escolar , Humanos , Masculino , Pielonefrite Xantogranulomatosa/microbiologiaAssuntos
Infecções por Escherichia coli/diagnóstico , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/microbiologia , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Diagnóstico Diferencial , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Pielonefrite Xantogranulomatosa/tratamento farmacológico , Tomografia Computadorizada por Raios X , UrináliseRESUMO
Xanthogranulomatous pyelonephritis is an uncommon chronic destructive granulomatous process of renal parenchyma in association with long-term urinary tract obstruction and infection. It affects females more often than males, with a wide range of age, from newborn to elderly. Almost all patients are symptomatic and the most common symptoms are flank or abdominal pain, lower urinary tract symptoms, fever, palpable mass, gross hematuria, and weight loss. The common laboratory findings are leukocytosis and anemia. Urine cultures most often reveal Escherichia coli and Proteus mirabilis . Computed tomography is the mainstay of diagnostic imaging for xanthogranulomatous pyelonephritis. Imaging studies may demonstrate diffuse or focal form. Histologically, xanthogranulomatous pyelonephritis presents a granulomatous inflammatory infiltrate composed of neutrophils, lymphocytes, plasma cells, xanthomatous histiocytes, and multinucleated giant cells. The differential diagnosis includes clear cell renal cell carcinoma, papillary renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia, and megalocytic interstitial nephritis. Both antibiotics and surgery can be treatment options depending on the patient's disease status.
Assuntos
Pielonefrite Xantogranulomatosa/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Escherichia coli/isolamento & purificação , Feminino , Células Gigantes/patologia , Humanos , Rim/patologia , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Proteus mirabilis/isolamento & purificação , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/terapia , Fatores Sexuais , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
We describe what is to our knowledge the first case of xanthogranulomatous pyelonephritis combined with nephrocutaneous fistula caused by Providencia rettgeri. Surgical extirpation including nephrectomy and fistulectomy was successfully performed. The strain was identified by 16S rRNA gene sequencing in both renal tissue and pus culture from the fistula.
Assuntos
Fístula Cutânea/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Nefropatias/microbiologia , Providencia , Pielonefrite Xantogranulomatosa/microbiologia , Fístula Urinária/microbiologia , Adulto , Fístula Cutânea/cirurgia , Infecções por Enterobacteriaceae/patologia , Infecções por Enterobacteriaceae/cirurgia , Humanos , Nefropatias/cirurgia , Masculino , Providencia/isolamento & purificação , Pielonefrite Xantogranulomatosa/cirurgia , Fístula Urinária/cirurgiaAssuntos
Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Enterococcus faecalis/isolamento & purificação , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Pielonefrite Xantogranulomatosa/microbiologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Xanthogranulomatous pyelonephritis is a chronic, inflammatory disease of the kidney rarely found in the pediatric population. We report the case of a 16-year-old boy with fever, microscopic hematuria, and an enlarging cystic renal mass on ultrasonography. The patient had no evidence of renal stones and no known risk factors, other than a recent tattoo performed with unsterile equipment. Because the differential diagnoses included Wilms tumor, he underwent open exploration and nephrectomy. The histopathologic findings were consistent with xanthogranulomatous pyelonephritis, and cultures grew methicillin-resistant Staphylococcus aureus. The etiology was believed to be bacterial seeding from the unsterile tattoo.
Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pielonefrite Xantogranulomatosa/etiologia , Infecções Estafilocócicas/etiologia , Tatuagem/efeitos adversos , Infecção dos Ferimentos/complicações , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Terapia Combinada , Diagnóstico Diferencial , Febre/etiologia , Hematúria/etiologia , Humanos , Neoplasias Renais/diagnóstico , Masculino , Nefrectomia , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Ultrassonografia , Infecção dos Ferimentos/microbiologiaAssuntos
Infecções por Escherichia coli/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso de 80 Anos ou mais , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Pielonefrite Xantogranulomatosa/tratamento farmacológico , Pielonefrite Xantogranulomatosa/microbiologiaRESUMO
Xanthogranulomatous pyelonephritis (XPN) is a rare form of chronic pyelonephritis, which is usually caused by calculous obstructive uropathy. We present a previously healthy 45-year-old housewife, who was admitted to The Dammam Central Hospital, Dammam, Saudi Arabia with left loin pain and increased frequency of micturition of four days duration. She also had icterus and features of disseminated intravascular coagulation. Abdominal ultrasound and computed tomography of the abdomen was suggestive of XPN. She responded well to treatment with antibiotics and nephrectomy. Histology of the resected kidney confirmed a diagnosis of XPN. Our case suggests that the diagnosis of XPN should be kept in mind when a middle-aged female patient presents with unilateral non-functioning hydronephrotic kidney, which is totally distorted, and has enhancing as well as non-enhancing regions on computed tomography.
Assuntos
Pielonefrite Xantogranulomatosa/complicações , Pielonefrite Xantogranulomatosa/diagnóstico , Cálculos Ureterais/complicações , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/patologia , Escherichia coli/isolamento & purificação , Feminino , Dor no Flanco/etiologia , Dor no Flanco/patologia , Humanos , Icterícia/etiologia , Icterícia/patologia , Pessoa de Meia-Idade , Pielonefrite Xantogranulomatosa/etiologia , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/patologia , Pionefrose/microbiologia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/patologiaRESUMO
La pielonefritis xantogranulomatosa (PX) es una rara infección crónica y severa del parénquima renal. Debido a que sus manifestaciones simulan una neoplasia, el diagnóstico preoperatorio es dificultoso. Habitualmente se asocia a infección bacteriana monomicrobiana. Nosotros comunicamos el caso de PX asociada a infección polimicrobiana, una de las cuales es un microorganismo anaeróbico
Assuntos
Humanos , Feminino , Adulto , Bactérias Anaeróbias/isolamento & purificação , Infecções Bacterianas/complicações , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/microbiologia , Anti-Infecciosos , Ciprofloxacina/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Pielonefrite Xantogranulomatosa/tratamento farmacológicoAssuntos
Humanos , Masculino , Pré-Escolar , Nefrectomia , Pielonefrite Xantogranulomatosa/cirurgia , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/etiologia , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/terapia , Dor Abdominal/complicações , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Nefropatias Diabéticas/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Infecções Urinárias/diagnóstico por imagem , Idoso , Infecções Bacterianas , Doença Crônica , Humanos , Pielonefrite Xantogranulomatosa/microbiologia , Tomografia Computadorizada por Raios XRESUMO
The genitourinary tract is well recognized as a route through which bacteria could gain access to the blood circulation. Under some circumstances, metastatic infections may occur in distant organs, including endogenous endophthalmitis. Xanthogranulomatous pyelonephritis (XGP) is an unusual variant of chronic pyelonephritis. It most often occurs in middle-aged women who frequently have a history of recurrent urinary tract infections combined with obstruction and a kidney of poor function. We reported an unusual case of urinary tract infection in a non-nephrolithiasis and non-obstructive urinary tract complicated by Klebsiella pneumoniae endogenous endophthalmitis and developed XGP in two months.
Assuntos
Endoftalmite/etiologia , Cálculos Renais/complicações , Infecções por Klebsiella/complicações , Klebsiella pneumoniae/isolamento & purificação , Pielonefrite Xantogranulomatosa/etiologia , Doenças Urológicas/complicações , Idoso , Endoftalmite/microbiologia , Endoftalmite/patologia , Humanos , Cálculos Renais/microbiologia , Cálculos Renais/patologia , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/patologia , Masculino , Pielonefrite Xantogranulomatosa/microbiologia , Pielonefrite Xantogranulomatosa/patologia , Doenças Urológicas/microbiologia , Doenças Urológicas/patologiaRESUMO
We report the case of a 6-y-old boy with actinomycosis, presenting as xanthogranulomatous pyelonephritis (XGP), hepatic pseudotumor and abdominal abscess. Symptoms included intermittent fever, abdominal pain and significant weight loss. Hepatic and renal tumor masses were suspected on sonography and computerized tomography. XGP and actinomycosis were proven by pathology. The patient recovered well with antibiotic alone.