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    "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&#44; dysuria and fever&#46; Empiric treatment was started with ceftriaxone 2&#8239;g&#47;24&#8239;h due to suspected acute pyelonephritis&#46; Although the blood cultures were negative&#44; the urine culture was positive for <span class="elsevierStyleItalic">Proteus mirabilis&#46;</span> Computed axial tomography revealed the presence of several low-density rounded areas surrounded by a contrast-induced margin that corresponded with dilated calyxes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Given the radiological findings&#44; we proceeded to perform en bloc nephrectomy&#46; The surgical specimen showed yellowish necrotic material surrounded by layers of orange-colored tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Histopathology confirmed the presence of necrosis and macrophages with abundant lipid accumulation&#46;</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&#46; Most cases occur in middle-aged women with a history of recurrent urinary tract infections&#46; Typical presentation symptoms include lower back pain&#44; fever and general discomfort&#46; The physical examination can reveal a unilateral renal mass&#46; The condition is generally caused by <span class="elsevierStyleItalic">Escherichia coli</span> or <span class="elsevierStyleItalic">Proteus mirabilis</span> infections&#44; and its treatment is surgical&#44; after a regimen of antibiotics to control the local infection&#46; The recommended surgical approach for these entities is lumbotomy&#44; accessing the retroperitoneal space to perform the nephrectomy&#44; which avoids contaminating the intraperitoneal cavity&#46; Given the condition&#8217;s clinical presentation and its radiological appearance&#44; the most common differential diagnosis is with renal carcinoma&#46; Septic pulmonary emboli mimicking metastatic malignancies have also been reported&#46;</p></span>"
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April 2021 Xanthogranulomatous pyelonephritis
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Vol. 221. Issue 4.
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Vol. 221. Issue 4.
Pages 245-246 (April 2021)
Medicine in Images
DOI: 10.1016/j.rceng.2019.06.012
Xanthogranulomatous pyelonephritis
Xanthogranulomatous pyelonephritis
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J. Lorca Álvaro
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javier.lorca.alvaro@gmail.com

Corresponding author.
, M. Santiago González, I. Laso García
Departamento de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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