Medical history A 47-year-old female presents to the emergency department complaining of back and left flank pain for two weeks. She also presents weakness and bilious vomiting. Recently, she was treated for urinary tract infection, with no improvement. On examination, the patient is pale (1+/4+), afebrile in regular general state, there are diffusional abdominal pain, mass presence on the left and costovertebral angle tenderness on the same side. Laboratory findings: Hb 5,9 g/dL, global leukocytes 13900/mm3, CRP 220 mg/L, urinalysis revealed 15 leukocytes/camp and no presence of bacteria. Image 1: Contrast-enhanced computed tomography (CT) scan of the abdomen, arterial phase, axial section.Image 2: Contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis, venous phase, coronal section. Question:Considering the case above and the images findings, what is the next step in treatment? Intravenous antibiotics and conservative management to treat acute pyelonephritis. Surgical treatment, total laparotomy nephrectomy to treat chronic pyelonephritis. Surgical treatment, flexible ureteroscopy and laser lithotripsy to treat ureterolithiasis. Intravenous antibiotics and percutaneous drainage to treat renal abscess. Test question Secretaria Estadual de Saúde - PE: Processo Seletivo de residência médica, 2019.Pergunta:About Xanthogranulomatous Pyelonephritis, it is CORRECT to state that: It is most often found in men in the 5th decade of life, associated with prostatitis. The most common treatment is prolonged antibiotic therapy, for at least 28 days. The diagnosis is, in most cases, radiological, with computed tomography being the gold standard. It has acute evolution, revealing fever and back pain in 48 hours. Time is Up! Time's up
