Xanthogranulomatous like Pyelonephritis with no Xanthoma Cells: Should these Always be Present?

We recently experienced an uncommon picture of a rare form of pyelonephritis. A 55 year old Indonesian woman, who had been living in Saudi Arabia for 35 years, and who had been unwell for 5 months, was admitted with fever, abdominal pain, dysuria and loss of weight. She had no history of hypertension, diabetes mellitus or analgesic abuse, but had repeated urinary tract infections and the patient passed urinary stones twice previously.