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Xanthogranulomatous pyelonephritis
Xanthogranulomatous pyelonephritis
J. Lorca Álvaro
, M. Santiago González, I. Laso García
Corresponding author
Departamento de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Lorca Álvaro, M. Santiago González, I. Laso García" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Lorca Álvaro" "email" => array:1 [ 0 => "javier.lorca.alvaro@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Santiago González" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Laso García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Xanthogranulomatous pyelonephritis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 409 "Ancho" => 1405 "Tamanyo" => 123832 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This case involves a 27-year-old woman with a history of recurrent urinary tract infections who was admitted to the emergency department with pain in the left lumbar region, dysuria and fever. Empiric treatment was started with ceftriaxone 2 g/24 h due to suspected acute pyelonephritis. Although the blood cultures were negative, the urine culture was positive for <span class="elsevierStyleItalic">Proteus mirabilis.</span> Computed axial tomography revealed the presence of several low-density rounded areas surrounded by a contrast-induced margin that corresponded with dilated calyxes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Given the radiological findings, we proceeded to perform en bloc nephrectomy. The surgical specimen showed yellowish necrotic material surrounded by layers of orange-colored tissue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Histopathology confirmed the presence of necrosis and macrophages with abundant lipid accumulation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Pyelonephritis xanthogranulomatous is an uncommon variant of chronic pyelonephritis in which massive kidney destruction by granulomatous tissue occurs. Most cases occur in middle-aged women with a history of recurrent urinary tract infections. Typical presentation symptoms include lower back pain, fever and general discomfort. The physical examination can reveal a unilateral renal mass. The condition is generally caused by <span class="elsevierStyleItalic">Escherichia coli</span> or <span class="elsevierStyleItalic">Proteus mirabilis</span> infections, and its treatment is surgical, after a regimen of antibiotics to control the local infection. The recommended surgical approach for these entities is lumbotomy, accessing the retroperitoneal space to perform the nephrectomy, which avoids contaminating the intraperitoneal cavity. Given the condition’s clinical presentation and its radiological appearance, the most common differential diagnosis is with renal carcinoma. Septic pulmonary emboli mimicking metastatic malignancies have also been reported.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-29" "fechaAceptado" => "2019-06-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorca Álvaro J, Santiago González M, Laso García I. Xanthogranulomatous pyelonephritis. Rev Clin Esp. 2021;221:245–246.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 409 "Ancho" => 1405 "Tamanyo" => 123832 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022100000004/v2_202104080754/S2254887419302334/v2_202104080754/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000004/v2_202104080754/S2254887419302334/v2_202104080754/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419302334?idApp=WRCEE" ]
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