Xanthogranulomatous Pyelonephritis (XGPN) in a Child with Multiple Ureteric Calculi.

Xanthogranulomatous pyelonephritis (XGPN) is an unusual suppurative granulomatous reaction to chronic renal infection, often in the presence of chronic obstruction, characterised histologically by granulomatous reaction with giant cells and foamy histiocytes1. XGPN is rare in children2. We report a case of XGPN, in a child with multiple lower ureteric calculi. An 11 year old male child presented to us, with features suggestive of acute pyelonephritis of two months duration.complete evaluation including contrast CT of the abdomen a diagnosis of XGPN was made. As the renal unit in question was non functional, he was treated successfully by subcapsular nephrectomy. This case is presented to emphasise the fact that, it is very important to diagnose XGPN early and differentiate it from chronic pyelonephritis. Prolonged antibiotic therapy and surgery is invariably required to relieve the obstruction and to eradicate the infection in patients with XGPN.

Congenital Right Intrathoracic Stomach Secondary to Hiatus Hernia in an Infant.

A four month old, female infant presented with acute onset respiratory distress and persistent, non-bilious vomiting for one day. The initial chest radiograph showed two large, fluid filled structures in the right hemi thorax. An upper GI contrast study showed right intrathoracic stomach with hold-up of barium in the pylorus. A diagnosis of congenital right intra-thoracic stomach with organo-axial torsion was made and patient underwent laparotomy and repair of the hiatal defect. The child is asymptomatic on follow up. The case is reported for unusual symptomatic presentation on early infancy.

Unimicrobial appendicitis due to non-vaccine serotype of streptococcus pneumoniae: Implications for and management and prevention.

The aetiology of appendicitis is usually polymicrobial. We report a rare case of appendicitis caused by Streptococcus pneumoniae as the only causative organism. The case assumes significance because it occurs in the absence of any predisposing factor for invasive pneumococcal infection, it is unimicrobial, it may lead to the misdiagnosis of primary peritonitis due to pneumococcus, and it undermines the efficacy of polyvalent pneumococcal vaccine.