Septic shock secondary to xanthogranulomatous pyelonephritis: A case report and literature review

Abstract

Introduction: Xanthogranulomatous pyelonephritis is described by histopathology as a destruction of the renal parenchyma and replaced by a chronic infiltrate of lipid-laden macrophages. It is known that patients with xanthogranulomatous pyelonephritis have a high rate of perioperative and postoperative morbimortality; however, there are few case reports on this entity. Case Report: A 35-year-old woman attended the emergency department due to the presence of pain in the left flank, accompanied by an altered state of consciousness and respiratory distress. The study protocol started, identifying a significant increase in the left kidney, the presence of a central staghorn stone, dilated minor calices, and clinically with septic shock. The clinical conditions improved by adding intravenous fluids, vasoactive amines, red blood cells concentrates, and broad-spectrum antibiotics. Subsequently, a left nephrectomy was performed. On the following days, the septic shock gradually resolved, leading to the patient’s discharge. Eventually, histopathology report was reviewed, confirming a xanthogranulomatous pyelonephritis. Conclusion: When a xanthogranulomatous pyelonephritis clinical suspicion is found, it is considered a surgical emergency. Furthermore, if proper management is not given immediately, there is a high risk of complications and death. However, the current statistics in Mexico have not been updated to contrast these data.