August 2023

UROLOGY

CASE REPORT: XGP IN A 77-YEAR-OLD FEMALE PATIENT

A 77-year-old female patient was referred to the Northwestern Medicine Complex Urologic Infections Program (CUIP) for management of xanthogranulomatis pyelonephritis (XGP).  She initially presented to another hospital with cognitive decline.
 
She underwent a stroke evaluation that was unrevealing, but clinicians noted that she had a urine culture with a low colony count of bacteria and was discharged with a short course of antibiotics for a possible UTI. She then had acute worsening in mental status and presented to Northwestern Memorial Hospital.  
 
As part of the evaluation, her care team obtained a CT of the abdomen and pelvis, showing a large staghorn calculus of the right kidney as well as parenchymal changes consistent with XGP. She was treated with a course of antibiotics for kidney infection and then discharged with a plan for later surgical management with a nephrectomy.
 
Due to the complexity and rarity of her infection, she was referred to the CUIP. The team there quickly identified the severity of her underlying illness and potential for recurrent sepsis. They directed her to a more expedited treatment path. The patient needed to be immediately readmitted to be stabilized on antibiotics while awaiting definitive surgical management.
 
Her condition was managed on antibiotics, and she remained an outpatient until the time of surgery. Her surgery was successful and uncomplicated, and she was doing well at her four-month follow-up.
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