A 58-year-old patient of sub-Saharan origin came to the emergency department with sweating and fever with left lumbar pain, heaviness in the left flank and dysuria for about 15 days.
His personal history did not include any significant pathology: No DM. No hypertension. No known allergies. Former smoker for 8 years. No haematuria. No colic. No UTIs.
He reports that in the last two weeks he has had occasional fever, sweating, heaviness in the left flank with lumbar pain on the same side and voiding symptoms with an acceptable urinary stream, dysuria, not shortness of breath, no dribbling, no urgency with night-time voiding once and daytime voiding every 3-4 hours with a feeling of complete emptiness.
Physical examination revealed an abdominal mass effect in the left flank on deep palpation. Rectal examination showed a grade I-II prostate without suspicious lesions.
Complementary tests showed: normal haemogram with signs of eosinophilia. Normal biochemistry. Other normal, negative urine analysis. X-ray of the genito-urinary tract showed a mass effect in the left flank that blurred the psoas line on that side. Renal ultrasound: multiple cysts in the left kidney. Abdominopelvic CT scan: cystic lesions with daughter vesicles, compatible with renal hydatid disease.
Echinococcus/Hemag antibody serology was requested, which was POSITIVE at figures above 1/2.621.440.
The study was completed with MRI to obtain a more complete iconography and to assess relations with adjacent structures.
In view of the suspected diagnosis, surgery was decided on the affected renal unit, it being impossible to perform conservative surgery during the surgical procedure and the patient underwent a complete left nephroureterectomy due to suspicion of communication of the hydatid cyst with the duct due to the thickness of the duct. Prior to surgical treatment, the patient received a course of Albendazole and another after surgery.
After treatment, the patient's antibody titration figures fell and three years after the procedure the patient is asymptomatic and analytically free of disease.
