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.