Bilateral Xanthogranulomatous Pyelonephritis in a Patient With Spina Bifida and Neurogenic Bladder: A Case Report.
Dagmawi Dereje Wale, Heera Tesfaye Erega, Iman Omer et al.
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Case in brief
A 30-year-old man with spina bifida and neurogenic bladder managed by intermittent catheterization presented with respiratory distress, profound anemia, and declining function. Imaging showed severe bilateral hydronephrosis, extensive renal parenchymal destruction and calcifications, and right staghorn calculi, consistent with advanced bilateral xanthogranulomatous pyelonephritis (XGP). He developed septic shock and respiratory failure; nephrostomy drainage produced purulent material, with cultures growing Morganella morganii and two Candida species. Renal failure required dialysis. Definitive surgery was deferred because of anatomical deformities, instability, and operative risk. He was discharged to long-term acute care and later died from tracheostomy-related complications.
What made this case unusual
The notable feature was advanced bilateral XGP in a patient with neurogenic bladder, accompanied by extensive renal destruction and systemic instability that made definitive surgical source control prohibitive.
Diagnostic / clinical pearl
In a patient with neurogenic bladder and impaired urologic follow-up, severe bilateral hydronephrosis with renal destruction and calcifications should raise concern for advanced XGP; bilateral disease may leave few feasible options for definitive source control.
Why it matters
The case illustrates how urinary obstruction, recurrent infection, and disrupted longitudinal follow-up may coexist with upper urinary tract deterioration, although their individual contributions to this patient's progression cannot be established.