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Case Reports
. 2018:22:17-150.
doi: 10.7812/TPP/17-150.

Pyeloduodenal Fistula in Xanthogranulomatous Pyelonephritis: A Series of Two Cases

Sara Dawoud  1 , Rachele J Solomon  2 , Stephanie A Eyerly-Webb  3 , Neil A Abrahams  4 , Fernando Pedraza  5 , Juan D Arenas  6 , Tjasa Hranjec  7
Affiliations
Case Reports

Pyeloduodenal Fistula in Xanthogranulomatous Pyelonephritis: A Series of Two Cases

Sara Dawoud et al. Perm J. 2018.

Abstract

Xanthogranulomatous inflammation, characterized by destruction and replacement of tissues with chronic inflammatory cells, including foamy histiocytes and hemosiderin-laden macrophages, is uncommon. In patients with xanthogranulomatous pyelonephritis, inflammation may extend from the kidney to the overlying duodenum, creating a pyeloduodenal fistula that further complicates medical and surgical management. We present two cases with recurrent kidney infections who each ultimately received a nephrectomy and repair of their duodenal fistula.

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Conflict of interest statement

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Coronal (top) and axial (bottom) contrast-enhanced computed tomography images of the patient’s abdomen from Case 1, showing a sclerotic right kidney (long arrow) and kidney stones (dashed arrows). The psoas abscess (short arrow) can be seen posterior to the kidney stones.
Figure 2
Figure 2
Hemotoxylin and eosin stain (40× magnification) of the biopsy from Case 1 showing pyelonephritis and abscess (lower right corner) with large areas of mononuclear inflammatory cells (center) surrounding areas of necrosis.
Figure 3
Figure 3
Axial (top and bottom) computed tomography images of the patient’s abdomen from Case 2. The top image shows the nephrocutaneous fistula tract with air (long arrow) and the staghorn calculus (dashed arrow). In the bottom image, the thinning kidney parenchyma (short thick arrow) and fistulous tract (long arrow) can be seen in the retroperitoneum.
Figure 4
Figure 4
Photomicrograph (Periodic-acid Schiff stain, 400× magnification) of the kidney biopsy from Case 2 showing interstitial infiltrates composed of epitheliod histiocytes/macrophages (black arrow) with positive granular content without Michaelis-Gutman bodies within the cells.
See this image and copyright information in PMC

References

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