Why XANTHOGRANULOMATOUS Pyelonephritis [XGP]

in brs-africa •  11 days ago

    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:

    1. Initially, it is confined within the kidneys, giving the classical
      presentation of Pyelonephritis.
    2. Then, it spreads beyond the kidney, but still limited by
      Gerota's fascia. At this stage, it gives features of a perinephric
      abscess.
    3. Finally, it erodes into surrounding structures: intestine,
      spleen, skin, and rarely a lung, usually through the
      costovertebral triangle-- the weakest part of the diaphragm.
      220px-Blausen_0428_Gallbladder-Liver-Pancreas_Location.png
      Source

    TREATMENT AND PROGNOSIS
    Treatment involves:

    1. Antibiotic therapy to cover for enteric bacteria, especially E
      coli, Proteus mirabilis, and Pseudomonads.
    2. Surgical drainage of abscess and fistulous connection.
    3. Most people would need the affected kidney removed
      surgically later.

    Given the country, and the index patient's financial
    constraints, prognosis here is terribly poor.
    Pity!

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