PMC5939034_01
A 49-year-old male with a history of high-grade T1 urothelial cell carcinoma of the bladder undergoing induction bacillus Calmette-Guerin immunotherapy. Initial presentation with fevers and chills after 3 weeks (4 of 6 treatments) of intravesical bacillus Calmette-Guerin therapy. (a) Axial contrast-enhanced computed tomography scan of the abdomen through the level of the kidney showing mass-like low attenuation lesion (yellow star) in the interpolar region of the right kidney with moderate surrounding perinephric inflammatory changes (blue arrow). (b) Coronal reformat contrast-enhanced computed tomography scan of the abdomen and pelvis showing mass-like low attenuation lesion (yellow star) in the interpolar region of the right kidney with moderate surrounding perinephric inflammatory changes (blue arrow). There is also mild diffuse bladder wall thickening (red arrow).
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F1
Contrast-enhanced CT (CECT) scan of the abdomen which was performed as part of the workup showed a roughly 2 cm mass-like area in the lower pole of the right kidney with moderate perinephric inflammatory changes [Figures 1a and b].
A 49-year-old male with a history of high-grade T1 urothelial cell carcinoma of the bladder undergoing induction bacillus Calmette-Guerin immunotherapy. Initial presentation with fevers and chills after 3 weeks (4 of 6 treatments) of intravesical bacillus Calmette-Guerin therapy. (a) Axial contrast-enhanced computed tomography of the abdomen through the level of the kidneys shows low attenuation lesions (yellow star) in the interpolar region of the right kidney with improving perinephric inflammatory changes 3 weeks later (blue arrow). (b) Coronal reformat contrast-enhanced computed tomography scan through the abdomen showing low attenuation lesions (yellow star) in the interpolar region of the right kidney with improving perinephric inflammatory changes 3 weeks later (blue arrow).
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F2
A primary renal mass was suspected, and a repeat CECT scan performed 3 weeks later demonstrated a persistent mass-like hypodense lesion in the right kidney with significantly improved perinephric inflammatory changes [Figures 2a and b].
A 49-year-old male with a history of high-grade T1 urothelial cell carcinoma of the bladder undergoing induction bacillus Calmette-Guerin immunotherapy. Initial presentation with fevers and chills after 3 weeks (4 of 6 treatments) of intravesical Bacillus Calmette-Guerin therapy. (a) Axial computed tomography of the abdomen through the level of the kidneys demonstrates a percutaneous computed tomography-guided biopsy of the lesion (blue circle). (b) Core needle biopsy from right renal mass showing marked chronic inflammation with granulomas (red circles). Special stains for acid-fast bacilli (Fite) and fungi (GMS) were negative (not shown).
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F3
Primary renal malignancies such as renal cell carcinoma and urothelial cell carcinoma and infiltrative masses such as lymphoma continued to be the main suspicions, and a CT-guided biopsy was recommended for histological confirmation [Figure 3a]. Histopathology confirmed marked chronic inflammation and necrotizing granulomas without evidence for malignancy [Figure 3b].
A 49-year-old male with a history of high-grade T1 urothelial cell carcinoma of the bladder undergoing induction bacillus Calmette-Guerin immunotherapy. Initial presentation with fevers and chills after 3 weeks (4 of 6 treatments) of intravesical bacillus Calmette-Guerin therapy. (a) Axial contrast-enhanced computed tomography scan of the abdomen through the level of the kidneys showing interval resolution of the right renal lesions with mild residual cortical scarring 8 months later (blue arrow). (b) Coronal reformat contrast-enhanced computed tomography scan showing interval resolution of the right renal lesions with mild residual cortical scarring 8 months later (blue arrow).
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F4
Eight months later, a CECT scan showed interval resolution of the right renal lesions with mild residual cortical scarring [Figures 4a and b].