[Abdominal mass revealing xanthogranulomatous pyelonephritis in an infant]

Area of Science:

• Pediatric Nephrology
• Pediatric Urology
• Pathology

Background:

• Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory kidney disease.
• It predominantly affects adults but can occur in children, often presenting with vague symptoms that delay diagnosis.
• Management typically involves medical therapy, but surgical intervention is frequently required, often leading to poor renal outcomes.

Observation:

• A 15-month-old infant presented with an isolated left flank mass.
• The infant lacked typical signs of infection such as fever and had sterile urine cultures.
• Radiological imaging revealed a non-functioning left kidney with features suggestive of hydronephrosis, raising suspicion for XGP.

Findings:

• Diagnostic imaging included renal ultrasound, uroscan, and renal scintigraphy.
• These investigations indicated a non-functioning left kidney, initially presumed to be hydronephrosis.
• Surgical nephrectomy confirmed diffuse Xanthogranulomatous pyelonephritis upon pathological examination.

Implications:

• This case highlights the importance of considering XGP in infants with renal masses or malformations.
• Vague symptomatology and sterile urine cultures can mask this serious condition.
• Prompt and accurate diagnosis followed by rigorous, codified treatment is essential for improved patient prognosis.