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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 …
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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