Complex therapy of spondylodiscitis developed on the basis of xanthogranulomatous pyelonephritis
DOI: 10.22591/magyurol.2021.2.antalt.75
Authors:
Antal Tamás dr., Osváth Péter dr., Szűcs Miklós dr.
Debreceni Egyetem, Klinikai Központ, Kenézy Gyula Campus, Urológiai és Andrológiai Osztály, Debrecen (osztályvezető: Szűcs Miklós dr.)
Summary
Introduction: Xanthogranulomatous pyelonephritis is a rare kind of chronic pyelonephritis, which usually caused by chronic urinary obstruction. According to literatures, xanthogranulomatous pyelonephritis is uncommon with a low percentage of the haematogenic spread, and no announcement of spondylodiscitis with such background has been found. The aim of this paper is to present the complex therapy of thoracic spondylodiscitis based on xanthogranulomatous pyelonephritis developed on the basis of impacted ureteral stone.
Case report: A 78-year-old male with paraplegia and uroszepszis was transferred to Emergency Department of Kenezy County Hospital for examination. Abdominal ultrasound showed left ureteral stone with diffuse dilation of the ureter and the renal pelvis. Lab tests resulted in higher inflammatory markers, impaired renal function and massive pyuria in the urine. Percutaneous nephrostomy was performed through an urgent operation immediately after a failed double-J insertion. After neurological and neurosurgical consultation, an urgent vertebral MRI was performed, consequently spondylodiscitis was found on the level of Th. X-XI Vertebrae; this was later proved by a CT guided core biopsy. Due to repeated neurosurgical and infectological consultation, primer decompressive operation was not available. Hence, the patient was given broad-spectrum antibiotics for six weeks. Control MRI showed mild regression of the thoracal spondylodiscitis. After a dynamic renal scan, nephrectomy via dorsal lumbotomy incision was performed and the histology proved the Xanthogranulomatous pyelonephritis was present. The rehabilitation started during the hospital stay and continued after hospital discharge by physiotherapists. During follow ups regression of neurological symptoms were found. Although the lower limb paraplegia is partly solved, the patient remained bed-bound.
Conclusion: This case report indicates that even in a typical occlusion case with severe neurological symptoms, neurological and neurosurgical consultations are necessary soon after an urgent urinary deviation. If spondylodiscitis is diagnosed 24-36 hours after the presentation of neurological symptoms, a decompressive operation is feasible. However, after this period, even with the neurosurgical procedure, full recovery cannot be achieved. Nonetheless, once spondylodiscitis is diagnosed, interdisciplinary approach is mandatory in order to eliminate the source of infection, avoid potential irreversible neurological complications and as a result, improving the patient’s quality of life.