Xanthogranulomatous Pyelonephritis in a Socioeconomically Disadvantaged Immigrant Child: A Case Report

Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory kidney disease characterized by progressive destruction of the renal parenchyma, typically associated with obstructive uropathy and nephrolithiasis. It is especially uncommon in pediatric patients and may be mistaken for malignancy or other renal infections, leading to delays in diagnosis. We present the case of a 13-year-old socioeconomically disadvantaged and immigrant (SDI) girl who developed advanced XGP due to unmonitored renal stones and limited access to healthcare. She presented with prolonged fever, flank pain, weight loss, and fatigue. Imaging revealed a non-functioning, enlarged right kidney with multiple staghorn calculi. Despite initial antibiotic therapy and percutaneous nephrostomy drainage, her condition progressed, necessitating nephrectomy. Histopathological examination confirmed XGP with lipid-laden macrophages, granulomatous inflammation, and fibrosis. Stone analysis revealed a mixed composition, primarily calcium oxalate and apatite variants, consistent with chronic infection-related calculi. This case highlights the potential severity of XGP when diagnosis and management are delayed, particularly in SDI populations. Clinicians should consider XGP in children presenting with recurrent urinary tract infections, renal calculi, and nonspecific systemic symptoms. Early recognition and timely surgical intervention, guided by a multidisciplinary team, are essential to prevent irreversible renal damage and reduce morbidity in pediatric patients with complicated urinary tract conditions.