Bilateral Xanthogranulomatous Pyelonephritis in a Patient With Spina Bifida and Neurogenic Bladder: A Case Report
- 1Department of Internal Medicine, Howard University Hospital, Washington, DC, USA
Abstract
Patient: Male, 30-year-old
Final Diagnosis: Xanthogranulomatosus pyelonephritis
Symptoms: Poor oral intake • shortness of breath • weigh loss
Clinical Procedure: —
Specialty: Critical Care Medicine • Infectious Diseases • General and Internal Medicine • Nephrology • Urology
Objective: Rare disease
Background: Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory renal infection associated with urinary obstruction, recurrent infections, and progressive renal parenchymal destruction. Bilateral involvement is exceedingly uncommon and associated with substantial morbidity and mortality, particularly in patients with neurogenic bladder and impaired longitudinal urologic follow-up.
Case Report: A 30-year-old man with spina bifida complicated by neurogenic bladder requiring intermittent catheterization presented with respiratory distress, profound anemia, and progressive functional decline. Imaging demonstrated severe bilateral hydronephrosis, diffuse renal parenchymal destruction and calcifications, and right-sided staghorn calculi, consistent with advanced bilateral XGP. The patient rapidly developed septic shock and acute-on-chronic hypercapnic respiratory failure requiring mechanical ventilation and vasopressor support. Percutaneous nephrostomy drainage yielded purulent material, and cultures grew Morganella morganii, Candida parapsilosis, and Candida tropicalis. His hospital course was complicated by dialysis-dependent renal failure, recurrent respiratory failure, and prolonged ventilatory dependence. Definitive surgical intervention was considered but deferred because of severe anatomical deformities, clinical instability, and prohibitive operative risk. After prolonged hospitalization, he was discharged to a long-term acute care facility but later died from complications related to tracheostomy.
Conclusions: This case illustrates the severe clinical consequences of advanced bilateral XGP in a high-risk patient with neurogenic bladder. The coexistence of recurrent infection, urinary obstruction, and disrupted longitudinal follow-up is consistent with recognized risk factors for upper urinary tract deterioration, although their individual contribution to this patient’s disease progression cannot be established. The case underscores the management challenges that arise when bilateral renal destruction and systemic instability limit definitive source-control options.
Related
- Xanthogranulomatous Pyelonephritis in a Horseshoe Kidney: Effective Conservative Therapy in an Immunocompromised Patient
- Morquio A syndrome associated with bilateral hydroureteronephrosis and neurogenic bladder: a rare case report and review of the literature.
- Diagnostic and Management Challenges in Xanthogranulomatous Pyelonephritis: A Case Report
- CT-based clinical deep learning radiomics nomogram for preoperative differentiation of pyelocaliceal upper tract urothelial carcinoma and xanthogranulomatous pyelonephritis
- Contrast-enhanced voiding urosonography - urodynamics in patients with neurogenic bladder dysfunction: a pilot study within pediatric urological practice
BibTeX
@article{wale2026bilateral,
title = {{Bilateral Xanthogranulomatous Pyelonephritis in a Patient With Spina Bifida and Neurogenic Bladder: A Case Report}},
author = {Dagmawi Dereje Wale and Heera Tesfaye Erega and Iman Omer and Alvin Billy and Advith Suresh and Tigabu Bishaw and Tadlo Belete and Tsebelu Shirshawa and Vishal A. Poddar and Shaheen Alvi},
journal = {The American Journal of Case Reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.954146},
url = {https://doi.org/10.12659/ajcr.954146},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Bilateral Xanthogranulomatous Pyelonephritis in a Patient With Spina Bifida and Neurogenic Bladder: A Case Report
AU - Dagmawi Dereje Wale
AU - Heera Tesfaye Erega
AU - Iman Omer
AU - Alvin Billy
AU - Advith Suresh
AU - Tigabu Bishaw
AU - Tadlo Belete
AU - Tsebelu Shirshawa
AU - Vishal A. Poddar
AU - Shaheen Alvi
PY - 2026
DA - 2026/10/26
JO - The American Journal of Case Reports
DO - 10.12659/ajcr.954146
UR - https://doi.org/10.12659/ajcr.954146
AB - Patient: Male, 30-year-old Final Diagnosis: Xanthogranulomatosus pyelonephritis Symptoms: Poor oral intake • shortness of breath • weigh loss Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases • General and Internal Medicine • Nephrology • Urology Objective: Rare disease Background: Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory renal infection associated with urinary obstruction, recurrent infections, and progressive renal parenchymal destruction. Bilateral involvement is exceedingly uncommon and associated with substantial morbidity and mortality, particularly in patients with neurogenic bladder and impaired longitudinal urologic follow-up. Case Report: A 30-year-old man with spina bifida complicated by neurogenic bladder requiring intermittent catheterization presented with respiratory distress, profound anemia, and progressive functional decline. Imaging demonstrated severe bilateral hydronephrosis, diffuse renal parenchymal destruction and calcifications, and right-sided staghorn calculi, consistent with advanced bilateral XGP. The patient rapidly developed septic shock and acute-on-chronic hypercapnic respiratory failure requiring mechanical ventilation and vasopressor support. Percutaneous nephrostomy drainage yielded purulent material, and cultures grew Morganella morganii, Candida parapsilosis, and Candida tropicalis. His hospital course was complicated by dialysis-dependent renal failure, recurrent respiratory failure, and prolonged ventilatory dependence. Definitive surgical intervention was considered but deferred because of severe anatomical deformities, clinical instability, and prohibitive operative risk. After prolonged hospitalization, he was discharged to a long-term acute care facility but later died from complications related to tracheostomy. Conclusions: This case illustrates the severe clinical consequences of advanced bilateral XGP in a high-risk patient with neurogenic bladder. The coexistence of recurrent infection, urinary obstruction, and disrupted longitudinal follow-up is consistent with recognized risk factors for upper urinary tract deterioration, although their individual contribution to this patient’s disease progression cannot be established. The case underscores the management challenges that arise when bilateral renal destruction and systemic instability limit definitive source-control options.
SN - 1941-5923
ER -