A 71-year-old man with masses in the pancreas, presacral region, and left kidney

Article Abstract:

Xanthogranulomatous pyelonephritis, an aggressive kidney inflammation, may be difficult to diagnose because its symptoms can suggest other disorders. A 71-year-old man with masses in the pancreas, midpelvis, and left kidney, and with retention of urine in the left kidney, was admitted to the hospital. He had experienced tuberculous pleurisy 47 years earlier, and chronic prostatitis and cystitis 28 years earlier. A needle biopsy of the masses in the pancreas and midpelvis revealed acute inflammation, giant cells, lymphocytes, and uniform cells of uncertain origin. Fluid in and thickening of the lining of the left lung were noted. Possible diagnoses that were ruled out included Balkan nephropathy, transitional-cell carcinoma of the renal pelvis, lymphoma, renal tuberculosis, and primary tumors of the retroperitoneum. Retroperitoneal fibrosis was discussed as another plausible diagnosis. The patient's left kidney was removed and microscopic examination of tissues confirmed the diagnosis of xanthogranulomatous pyelonephritis.

Pyelonephritis, Retroperitoneal fibrosis

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A 69-year-old woman with severe, persistent congestive heart failure after treatment for bacteremia

Article Abstract:

A 69-year-old woman with congestive heart failure following a bacterial blood infection was found to have inflammation of heart tissue, a calcified aortic valve, and a ruptured aneurysm at the base of the aorta. The woman had difficulty breathing, backflow of her aortic and mitral valves, heart arrhythmia, an enlarged left ventricle, and fluid in and around her lungs. There was a ballooning at the base of the aorta, an aneurysm, which had ruptured into the neighboring pulmonary artery which feeds the lungs. During surgery the infected aortic tissue and valve were removed and replaced with a transplant and the pulmonary artery was patched with a piece of the sac surrounding the heart. The patient did well following the surgery and the congestive heart failure subsided. The diseased aortic valve had deposits of platelets and fibrin containing bacteria.

Congestive heart failure, Aortic aneurysms, Aortic aneurysm, Aneurysm, Infected, Infected aneurysm

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A 67-year-old woman with vomiting, bloody diarrhea, and azotemia

Article Abstract:

A 67-year-old woman was admitted to a hospital because of nausea, vomiting and bloody diarrhea. She had been vacationing in Europe, where she developed symptoms one day after eating chicken. She was anemic and blood tests revealed that she had acute kidney failure. She was diagnosed with hemolytic-uremic syndrome, which in adults is often caused by E. coli strain O157:H7. A renal biopsy confirmed the diagnosis of kidney failure. She responded to dialysis, plasma exchange and corticosteroids. A stool sample was negative but blood samples sent to the CDC tested positive for E. coli O157:H7.

Health aspects, Escherichia coli infections, Hemolytic-uremic syndrome

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