Xanthogranulomatous pyelonephritis presenting as palmoplantar keratoderma.

A 60-year-old woman with type 1 diabetes mellitus and a history of repeated urinary tract infections due to Proteus mirabillis presented with diffuse palmoplantar hyperkeratosis of 4 months duration (figure 1) and acute retrosternal pain. An ECG showed a diffuse concave ST segmental elevation and the echocardiogram showed a mild pericardial effusion, suggestive of pericarditis. Laboratory analysis showed negative troponin, leucocytosis, elevated erythrocyte sedimentation rate (110 mm/h) and C reactive protein (10 mg/dL). A CT scan revealed a hydronephrotic, non-functioning left kidney with an inflammatory infiltrate in …