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Pleural empyema secondary to xanthogranulomatous pyelonephritis
  1. Adam Maxwell1,
  2. Alison Kent1,
  3. Marianne Tinkler1,
  4. Sunil Mathur2,
  5. Andy Beale3
  1. 1 Respiratory Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
  2. 2 Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
  3. 3 Radiology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
  1. Correspondence to Dr Adam Maxwell, Great Western Hospitals NHS Foundation Trust, Swindon SN3 6BB, UK; adam.maxwell{at}

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A 79-year-old woman presented to acute services with a 2-week history of shortness of breath, fever and a cough productive of purulent sputum. She had a medical history of polymyalgia rheumatica, chronic obstructive pulmonary disease and hypertension. She had been admitted with a right-sided pleural empyema 9 months earlier, which had been treated with chest tube drainage and intravenous antibiotics. On that occasion, pH of pleural fluid was 6.7, white cell count (WCC) ++, lactate dehydrogenase (LDH) 7554 U/L and total protein 39 g/L (serum total protein 73). Neither pleural fluid nor contemporaneous blood cultures had shown any significant growth.

In the past year, she had been found to have right-sided hydronephrosis with contrast-enhanced abdominal CT demonstrating a mass arising from the upper pole of the right kidney. Subsequent percutaneous-guided biopsy performed under the urology team identified prominent collections of foamy histiocytes, with immunohistochemical analysis demonstrating strongly positive staining for CD68 and vimentin. These findings were consistent with a diagnosis of xanthogranulomatous pyelonephritis, thought likely to be secondary …

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  • Contributors AM and AK equally wrote the manuscript. MT and SM revised and approved the manuscript. AB provided the radiology images with interpretation and revised and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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