A Case of Xanthogranulomatous Pyelonephritis with Nephropleural Fistula Formation: Role of MRI in Diagnosis and Treatment

Empyema complicated with nephropleural fistula and perinephric abscess

The coexistence of empyema, nephropleural fistula and perinephric abscess is rare and presents diagnostic challenges, especially when patients exhibit atypical or mild symptoms. This case report details a female in her early 90s who presented with 3 weeks of chest pain and was found to have a left-sided pleural effusion. Further imaging revealed additional findings of a left-sided nephropleural fistula and left perinephric collection. The patient underwent thoracentesis and video-assisted thoracoscopic surgery, with cultures growing Streptococcus Anginosus Subsequently, she underwent a left nephrectomy, with pathology findings consistent with chronic pyelonephritis and a fistulous tract. The patient was discharged on intravenous antibiotics. Follow-up imaging showed improvement. The patient completed the antibiotic course and reported symptom resolution 2 weeks after discharge.

Fatal nephrobronchial fistula arising from xanthogranulomatous pyelonephritis: a case report

Introduction

Nephrobronchial fistula is an exceptionally rare complication of renal infections, including the uncommon xanthogranulomatous pyelonephritis. Existing literature is limited to a few case reports, with antibiotic therapy and nephrectomy being the preferred treatments.

Case

We present the case of a 63-year-old woman with a history of recurrent xanthogranulomatous pyelonephritis in her right kidney, requiring drainage through lumbotomy. She presented with a chronic dry cough and weight loss, without other noticeable symptoms. Imaging suggested a pulmonary abscess and nephrobronchial fistula. Despite antibiotic treatment and surgical intervention, her condition progressed fatally.

Conclusion

Nephrobronchial fistulas are extremely complications of renal infections, often presenting with nonspecific symptoms. This case highlights their significant impact on morbidity and mortality, especially in resource-limited settings, and underscoring the urgent need for prompt diagnosis and treatment.

Xanthogranulomatous pyelonephritis - A diagnostic and therapeutic dilemma

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis, occurring in the setting of obstructive uropathy and recurrent urinary tract infections (UTIs). It is difficult to diagnose as it can be asymptomatic until late-stage disease. Localized symptoms such as flank pain and dysuria may be attributed to nephrolithiasis or UTIs without prompting need for further workup. Extrarenal manifestations, most notably fistula formation, may present distal to the kidney and not be readily attributed to a renal pathology. The only known definitive therapy is nephrectomy. A delay in diagnosis can lead to fulminant complications or a more technically difficult nephrectomy. We present three cases of XGP, which serve to highlight the possibility of earlier diagnosis and resultant management options, including the potential for nephron-saving strategies. Early clinical and radiologic suspicion through awareness of risk factors may play an important role in preventing disease progression, avoiding late-stage complications, and improving treatment outcomes.