Metastatic xanthogranulomatous pyelonephritis managed with immunosuppression

Area of Science:

• Nephrology
• Oncology
• Immunology

Background:

• Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic granulomatous inflammation of the kidney.
• This case presents a rare extra-renal manifestation of xanthogranulomatous disease.
• The patient had a history of type 2 diabetes mellitus, hypertension, and active smoking.

Purpose of the Study:

• To report a rare case of recurrent xanthogranulomatous disease with extra-renal involvement.
• To discuss the management of recurrent xanthogranulomatous disease with immunosuppressive therapy.

Main Methods:

• Diagnosis of xanthogranulomatous pyelonephritis via nephrectomy.
• CT imaging for detection of pulmonary and pancreatic lesions.
• Histological confirmation of xanthogranulomatous disease.
• Treatment with glucocorticoids and azathioprine.

Main Results:

• Initial diagnosis of xanthogranulomatous pyelonephritis after nephrectomy for a renal mass.
• Recurrence of xanthogranulomatous disease with pulmonary and pancreatic lesions 3 years post-diagnosis.
• Successful management with glucocorticoids and azathioprine, leading to stable renal function and no active inflammation for 2 years.

Conclusions:

• Xanthogranulomatous disease can manifest with extra-renal involvement and recur.
• Glucocorticoids and azathioprine are effective in managing recurrent xanthogranulomatous disease.
• Long-term immunosuppressive therapy can lead to disease stability.