Introduction.Pyelonephritis is an inflammation of the renal parenchyma primarily due to bacterial infections9. Chronic pyelonephritis can result in an unusual form of a disease known as Xanthogranulomatous pyelonephritis (XGP)9. Patients with this disease usually present with a chronic urinary tract obstruction due to an underlying renal calculus and urinary tract infections9. The most frequent organisms extracted from XGP patients are Escherichia coli (E. coli) and Proteus mirabilis, with different levels of antimicrobial resistance being presented2.XGP is marked by extensive damage to renal parenchyma which is then substituted by a focal collection of Xanthomatous mass of lipid-laden macrophages also known as foam cells 1, however, the exact etiology of XGP is still unknown. The disease is very rare, its incidence in the general population is 1.4 cases per 100,000 population each year 4. The highest incidence is at 50 to 70 years of age, with a female predominance. The most common clinical manifestation of XGP includes anemia, excessive weight loss, abdominal or frank pain, palpable frank mass, and fever 3.There is usually a challenge in establishing a correct diagnosis of XGP, this is because it mimics other renal pathologies 1. XGP has acquired the nickname of the “great imitator “, due to the matching of the radiological characteristics of other pathologies including renal cell carcinoma (RCC), Malakoplakia, Tuberculosis (TB), and urothelial tumors (TCC) 2.Management of XGP involves a combination of both medical and surgical approaches. A retrospective study was conducted to report the outcomes of XGP patients who underwent nephrectomy in their institution for over 12 years. Bacteriuria was found in most of the patients (91%), with Escherichia coli (E. coli) being the predominant organism. 60% of positive urine samples had antibiotic resistance. All patients underwent open nephrectomy except for one. It was concluded that open nephrectomy is often required in complicated cases of XGP, and it is associated with high rates of postoperative complications, however meticulous contemplation of antibiotics and surgical interventions is important to ensure the effective outcome of the patients 2. Here we share a rare case of a female with XGP.

INTRODUCTIONPyogenic granuloma is an acquired non-cancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma appears as a painless papule or lump that may bleed with or without minor trauma.(1)(2). Usually takes the form of a polypoid and can be further classified into subtypes including eruptive, dermal, intravascular, and subcutaneous. Head skin, oral mucosa, gingiva, trunk, neck, lower and upper extremities and perianal are the most common places, with the genital areas being the least common.(3). Vascular malformation, oral contraceptives, hormonal factors, pregnancy, and skin irritations resulting from trauma, poor hygiene, vasculitis, foreign objects, inflammatory skin conditions, oral retinoid therapy, and antiretroviral medication indinavir are among the factors that predispose an individual to this condition. Recent researches indicates that 7% of instances include mild trauma.(4)(5)(6)(7)(8). It is astounding that micro damage during sexual activity is prevalent while genital pyogenic granuloma is uncommon. (9)(10). We present a case of 24years old male who presented at our facility with distal penile ulcerated polypoidal nodules.

INTRODUCTIONPyoderma gangrenosum (PG) is a rare, primary sterile, inflammatory, non-infective, and non-malignancy skin disease that is classified into four variants (ulcerative, pustular, bullous, and vegetative) (Table 1). Up to 50% of PG cases might have systemic diseases such as hematological malignancy, rheumatoid arthritis, paraproteinemia, myeloproliferative disorder, and inflamatory bowel diseases such as Crohn’s disease and ulcerative colitis. It’s found that up to 5% of cases of PG have ulcerative colitis and 1.5% have Crohn’s disease (1), (2), (3), (4), (5). In the 1930s, Brunsting et al. were the first to define PG as a disease entity. They described it in five patients who presented with large, painful necrotic ulcers with undermined borders of bluish coloration enclosed by regions of erythema. In those five patients, four had ulcerative colitis. The cause is still unknown, though it was hypothetically thought to be a bacterial disease and sometimes a cutaneous manifestation of inflammatory bowel disease, which has been refuted by current studies (2).The incidence of PG annually in the United States is estimated to be 1 case in 100,000, while the worldwide incidence is between 3 and 10 million. General PG is a diagnosis of exclusion, with penile conditions having considerable differentials, including infections such as syphilis, amoebiasis, herpes simplex, mycobacterial ulceration, and non-infectious origins of venereal ulceration like cutaneous Crohn’s disease, squamous cell carcinoma, and ulcerating sarcoidosis. It should be considered in lesions where antimicrobial or antiviral therapy has not responded or for the non-confirmatory diagnosis of skin conditions (6). Frequently, PG occurs between the ages of 25 and 54, though it might occur at any age. It is extremely rare in pediatrics; 4% of cases have been reported in pediatrics and infants; in infants alone, 8.8% of all pediatric cases are reported. The youngest reported case is 3 weeks old. Females are more affected than males, and their peak age is in their third and fourth decades, while their counterpart males are in their fifth decade. The initial lesion is a tender pustule, whereas in infants, the areas involved are perianal and genital, and in children, the lesions involve the head, face, and gluteal areas (4).Typically, PG lesions start as small vesiculopustular, which progresses to an ulcer with violaceous overhanging borders, and these occur mostly in the lower extremities, though not limited to other organs. In this typical form, it is believed that if the condition is associated with arthritis, they become more refractory to treatment than those without arthritis. Atypical forms are clinically presented as superficial lesions with blue-gray bullous borders involving the extremities, head, and neck. Regardless of the presence of other systemic conditions, it can be acute or chronic. A PG patient presents with a condition called pathergy, which is the development of a lesion at a site of trauma, whether it be iatrogenic, animal bites, or any injury, and it is due to hyper-reactivity of the skin (8). Apart from PG, other conditions that may present with pathology are sweet syndrome, blindloop syndrome, erythema elevatum diutinum, and Behcet’s disease. Pathergy should not be confused with the Koebner/isomormorphic response, which is the formation of new skin lesions in areas that were not involved in trauma. 10–30% of PG reported cases are idiopathic; 20% of patients will present with a Koebner response, while 20–30% will present with pathology (9, 10).