• Pai-Yu Cheng, Yi-You Huang, Fu-Shan Jaw, and Shiu-Dong Chung.
• Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
• Medicine (Baltimore). 2023 May 12; 102 (19): e33787e33787.

RationaleXanthogranulomatous pyelonephritis (XGPN) is a form of chronic pyelonephritis caused by chronic calculus obstruction and bacterial infection, leading to the destruction of the renal parenchyma and calyces. Conservative treatment is usually not sufficient, and surgical intervention is still the main curative approach. XGPN with transdiaphragmatic extension and lung abscess formation is a rare condition.Patient ConcernsWe report a 64-year-old woman who presented with persistent productive cough.DiagnosesLung abscess secondary to XPGN. Both nephrostomy urine and sputum cultures showed Proteus mirabilis infection with the same antibiotic sensitivity spectrum, but blood culture was negative.InterventionsLaparoscopic radical nephrectomy and prolonged antibiotic treatment.OutcomesThe lung abscess and cough gradually resolved in 1 month after nephrectomy.ConclusionLung abscess secondary to transdiaphragmatic extension of XGPN is rare but should be considered in patients with lower lung infections that are unresponsive to treatment, especially infections due to unusual respiratory pathogens such as P mirabilis.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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