Sporadic bilateral synchronous multicentric papillary renal cell carcinoma masquerading as bilateral multifocal pyelonephritis

Ann R Coll Surg Engl. 2014 Jul;96(5):e7-10. doi: 10.1308/003588414X13814021679113.


Pyelonephritis is defined as an inflammation of the kidney and renal pelvis. The diagnosis is usually clinical. Acute multifocal bacterial nephritis is a rare form of pyelonephritis that is more severe and sepsis is more common. We report a patient who presented with fever and right-sided abdominal pain associated with right flank tenderness, suggesting right acute pyelonephritis. Bilateral multifocal pyelonephritis was diagnosed on ultrasonography, radionuclide renal scintigraphy and computed tomography. However, owing to non-resolution of symptoms, a biopsy was performed, which showed bilateral papillary renal cell carcinoma (PRCC). PRCC is known to exhibit multicentricity. To our knowledge, a case of bilateral multicentric PRCC masquerading as bilateral multifocal pyelonephritis has not been reported in the English literature. This case highlights the need to be vigilant while treating patients with focal lesions of the kidney as an inflammatory condition lest a malignancy should be missed.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Pain / etiology
  • Biopsy
  • Carcinoma, Renal Cell / pathology*
  • Diagnosis, Differential
  • Humans
  • Kidney Neoplasms / pathology*
  • Male
  • Middle Aged
  • Pyelonephritis / pathology*
  • Radiopharmaceuticals / therapeutic use
  • Technetium Tc 99m Dimercaptosuccinic Acid
  • Tomography, X-Ray Computed


  • Radiopharmaceuticals
  • Technetium Tc 99m Dimercaptosuccinic Acid

Supplementary concepts

  • Papillary renal cell carcinoma, sporadic