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A case of xanthogranulomatous pyelonephritis leading to nephrobronchial fistula and lung abscess: does it always manifest with respiratory symptoms?

Xanthogranulomatous pyelonephritis (XGP) is a serious manifestation of chronic kidney inflammation that can expand to adjacent structures. Here we report a case of XGP extending beyond the diaphragm through a nephrobronchial fistula to form a lung abscess in a 70-year-old man. The patient presented to the emergency department with severe right flank colic pain, nausea, vomiting and nonspecific constitutional symptoms for the past 4 months. Although the patient did not complain of any respiratory symptoms, initial evaluations revealed severe right-sided hydroureteronephrosis with debris, as well as an area of infiltration in the right lung lower lobe (RLL). Given the patient's condition, a thorough work-up was expedited to investigate the potential association between the symptoms. Ultimately, a diagnosis of XGP with expansion to the RLL through the right hemidiaphragm was developed. A right radical nephrectomy, right lower lobectomy and right hemidiaphragm resection were carried out. XGP was confirmed on the basis of the pathological evaluation of the resected specimens.