Xanthogranulomatous pyelonephritis presenting as giant hydronephrosis in young women: a very rare case report

Xanthogranulomatous pyelonephritis (XGP) is common in middle-age female, involved kidney usually is hydronephrotic, non-functioning and associated with stones but giant hydronephrotic presentation is a very rare. We report a case of 25-year-old female presented as huge cystic abdominal lump involving left hemi-abdomen and crossing midline associated with pain. On radiological evaluation, she had giant left non-functioning hydronephrotic kidney pushing small and large bowel on right side for which she underwent open simple nephrectomy. To our surprise, her histopathology report was Xanthogranulomatous pyelonephritis. Only one case reported till date of Xanthogranulomatous pyelonephritis presented as giant hydronephrosis in adult. Xanthogranulomatous pyelonephritis is very rare cause of giant hydronephrosis with a varying clinical and radiological presentation and difficult to diagnose preoperatively. Diagnosis of XGP should be entertained in case long-standing gross hydronephrotic obstructed, infected kidney with stone disease.