Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
J Emerg Med. 2024 Apr;66(4):e534-e537. doi: 10.1016/j.jemermed.2023.11.021. Epub 2023 Dec 5.
In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis.
A 30-year-old male patient presented to the ED for evaluation of right-sided abdominal pain that has been ongoing for the past 24 hours. He noted the pain was located predominantly in the right flank and described it as sharp in nature. The pain was nonradiating and was associated with scant hematuria. He stated that he had similar pains approximately 1 month earlier that resolved after a few days. The patient underwent a bedside ultrasound and a subsequent computed tomography (CT) scan of the abdomen and pelvis, which showed an enlarged, multiloculated right kidney with dilated calyces and a large staghorn calculus, findings that represent XGP. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights an unusual variant of pyelonephritis, a relatively common ED diagnosis. XGP should be considered in patients with recurrent pyelonephritis, as treatment for XGP may require surgical intervention in addition to traditional antibiotic management.
在急诊科（ED），肾盂肾炎是一种相当常见的诊断，特别是在单侧腰痛的患者中。黄肉芽肿性肾盂肾炎（XGP）是一种罕见的肾盂肾炎类型，其具有独特的特征，这可能导致其诊断。
一名 30 岁男性患者因持续 24 小时的右侧腹痛到 ED 就诊。他指出疼痛主要位于右侧腰部，性质为锐痛。疼痛无放射，伴有少量血尿。他表示大约 1 个月前有类似的疼痛，几天后自行缓解。患者接受了床边超声和随后的腹部和骨盆 CT 扫描，显示右肾增大、多房性，伴有扩张的肾盂和大鹿角状结石，这些表现提示 XGP。
为什么急诊医生应该注意到这一点？：本病例报告强调了肾盂肾炎的一种不常见变异，这是急诊科常见的诊断。对于复发性肾盂肾炎患者，应考虑 XGP，因为 XGP 的治疗除了传统的抗生素治疗外，可能还需要手术干预。
