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[Pseudotuberculous pyelonephritis associated with staghorn calculus: a case report]
Daisuke Ikeda1, Mamoru Fukuda, Hiroshi Takashima
1Department of Urology, Kouseiren Takaoka Hospital.
Summary
A patient presented with chronic pyelonephritis that mimicked renal tuberculosis histologically. Diagnosis was pseudotuberculous pyelonephritis due to the absence of Mycobacterium tuberculosis, avoiding unnecessary treatment.
Area of Science:
- Nephrology
- Pathology
- Infectious Diseases
Background:
- Chronic pyelonephritis can present with complex histopathological features.
- Renal tuberculosis is a significant differential diagnosis in cases of chronic kidney inflammation.
Observation:
- A 56-year-old woman presented with left flank pain, a staghorn calculus, and a retroperitoneal abscess.
- CT imaging revealed extensive retroperitoneal abscess extending from the kidney.
- Preoperative urine cultures were negative for bacteria, including mycobacteria.
Findings:
- Histopathological examination of the nephrectomy specimen showed caseating granulomas, characteristic of tuberculosis.
- Acid-fast bacilli and mycobacterial cultures from the renal lesion and abscess were negative.
- The final diagnosis was pseudotuberculous pyelonephritis, a rare entity.
Implications:
- Accurate diagnosis is crucial to differentiate pseudotuberculous pyelonephritis from renal tuberculosis.
- Awareness of this condition can prevent unnecessary and potentially harmful antitubercular therapy.
- This case highlights the importance of integrating clinical, imaging, and microbiological findings for definitive diagnosis.