Certain forms of relatively common diseases are uncommon. Such uncommon presentations of relatively common diseases still have very rare presentations. What's the likelihood of one seeing a very rare presentation of an uncommon form of a relatively common illness, especially
when the index case doesn't fit into the usual demographic?
Once-in-a-blue-moon occurrence, right?
XGP is a type of Pyelonephritis that behaves like a cancer,
having the potential to erode into surrounding tissues.
Its progression is usually in 3 stages:
- Initially, it is confined within the kidneys, giving the classical
presentation of Pyelonephritis.
- Then, it spreads beyond the kidney, but still limited by
Gerota's fascia. At this stage, it gives features of a perinephric
- Finally, it erodes into surrounding structures: intestine,
spleen, skin, and rarely a lung, usually through the
costovertebral triangle-- the weakest part of the diaphragm.
TREATMENT AND PROGNOSIS
- Antibiotic therapy to cover for enteric bacteria, especially E
coli, Proteus mirabilis, and Pseudomonads.
- Surgical drainage of abscess and fistulous connection.
- Most people would need the affected kidney removed
Given the country, and the index patient's financial
constraints, prognosis here is terribly poor.