Xanthogranulomatous pyelonephritis (XGP) is a rare and severe form of chronic pyelonephritis. We report a case of bilateral XGP complicated by extensive abscess formation. A 47-year-old man presented with fatigue and generalized weakness. Laboratory evaluation revealed leukocytosis and elevated serum creatinine levels. Urinalysis demonstrated pyuria and bacteriuria. Computed tomography (CT) revealed bilaterally enlarged kidneys with multifocal renal parenchymal and perirenal abscesses. The CT scan also demonstrated severe bilateral hydronephroureter and diffuse bladder wall thickening, with a radiologic impression of severe pyelonephritis with abscess formation and neurogenic bladder. The patient was admitted and treated with intravenous antibiotics and percutaneous nephrostomy tube placement. However, no clinical improvement was observed with conservative management. The patient subsequently underwent right open radical nephrectomy. Histopathological examination confirmed the diagnosis of XGP with extensive abscess formation. The patient experienced no further complications or recurrence after surgery. This case suggests that chronic untreated neurogenic bladder may contribute to the development of severe chronic pyelonephritis such as XGP.
Lee et al. (2026) studied this question.