Moudi Emadoddin, Darzi Mohammadmehdi, Ramzani Sepehr, Akbarzadeh Pasha Abazar
Department of Urology, Babol University of Medical Sciences, Babol, Iran.
Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Caspian J Intern Med. 2021;12(Suppl 2):S505-S508. doi: 10.22088/cjim.12.0.505.
Xanthogranulomatous pyelonephritis (XGP) is a rare and intense type of chronic kidney infection characterized by subversion of the renal tissue and its replacement by lipid- laden macrophages. XGP combined with emphysematous pyelonephritis(EPN) is rare and up until now only 7 cases with these presentations have been reported; so abundant clinical skills and appropriate radiographic imaging is required to reach the correct diagnosis. In this report, we present a case with two uncommon variants of pyelonephritis.
A 55-year-old female presented with a history of type 2 diabetes mellitus, and a stroke leading to a left-sided hemiplegia state for 7 years, coronary artery bypass grafting(CABG), hypertension(HTN) , seizure, progressive fatigue, loss of appetite , fecal and urinary incontinence and right costovertebral angle tenderness. According to clinical signs, symptoms and documentation of gas within the renal parenchyma on computed tomography (CT) of abdomen, of EPN diagnosis was suggested; however histopathologic evaluation showed acute emphysematous pyelonephritis on chronic xanthogranulomatous pyelonephritis.
EPN can emerge in a patient suffering from XPG which would add to the severity of the situation. In the case presented, concurrent underlying diseases such as diabetes mellitus, stroke, CABG, HTN along with severe fatigue and loss of appetite existed. Surgical treatment produces dramatic results.
黄色肉芽肿性肾盂肾炎（XGP）是一种罕见且严重的慢性肾脏感染类型，其特征是肾组织被破坏并被充满脂质的巨噬细胞取代。XGP合并气肿性肾盂肾炎（EPN）很罕见，截至目前仅有7例有此类表现的病例被报道；因此需要丰富的临床技能和合适的影像学检查才能做出正确诊断。在本报告中，我们呈现了一例患有两种不常见肾盂肾炎变体的病例。
一名55岁女性，有2型糖尿病病史，因中风导致左侧偏瘫状态7年，曾接受冠状动脉搭桥术（CABG）、患有高血压（HTN）、癫痫，出现进行性疲劳、食欲不振、大小便失禁以及右肋脊角压痛。根据临床体征、症状以及腹部计算机断层扫描（CT）显示肾实质内有气体，提示为EPN诊断；然而组织病理学评估显示为慢性黄色肉芽肿性肾盂肾炎合并急性气肿性肾盂肾炎。
EPN可出现在患有XPG的患者中，这会使病情更加严重。在本病例中，患者同时存在糖尿病、中风、CABG、HTN等基础疾病，伴有严重疲劳和食欲不振。手术治疗产生了显著效果。
