Connor Martin J, Habib Abul, Wen David, Kubba Faris, Raza Asif
Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
J Endourol Case Rep. 2019 Aug 30;5(3):113-116. doi: 10.1089/cren.2019.0030. eCollection 2019.
Filariasis is a tropical disease caused by infection with nematode parasites of the Filarioidea family. Filariasis is an endemic disease in parts of India, Sub-Saharan Africa, and Southeast Asia. Filariasis is a progressive disease predominantly affecting the lymphoreticular system, which can result in genitourinary complications (hydrocele, scrotal pain, and infertility), lymphedema, and elephantitis. Retroperitoneal fibrosis has a broad etiology, including secondary to chronic infection. Currently an estimated 25 million men are suffering from lymphatic filariasis with urogenital involvement worldwide. We present a rare case of a 40-year-old man presenting with fever, groin lymphadenopathy, and a history of infertility. Imaging confirmed significant hydronephrosis and retroperitoneal fibrosis. Filariasis serology was positive. Prior bilateral testicular biopsy demonstrated chronic inflammation and atrophy. Disease course was not improved by empirical eradication and supportive retrograde ureteral stenting. The patient developed elephantitis and progressive retroperitoneal fibrosis leading to a solitary functioning right kidney with nephrostomy. Urologists should be aware of index presentations of filariasis and its associated urological complications, particularly in the travelling adult population in whom the etiology of renal impairment and infertility remains unclear.
丝虫病是一种由丝虫科线虫寄生虫感染引起的热带疾病。丝虫病在印度部分地区、撒哈拉以南非洲和东南亚是一种地方病。丝虫病是一种主要影响淋巴网状系统的进行性疾病，可导致泌尿生殖系统并发症（鞘膜积液、阴囊疼痛和不育）、淋巴水肿和象皮肿。腹膜后纤维化病因广泛，包括继发于慢性感染。目前估计全球有2500万男性患有伴有泌尿生殖系统受累的淋巴丝虫病。我们报告一例罕见病例，一名40岁男性，表现为发热、腹股沟淋巴结病和不育史。影像学检查证实有严重肾积水和腹膜后纤维化。丝虫病血清学检查呈阳性。先前的双侧睾丸活检显示慢性炎症和萎缩。经验性根除和逆行输尿管支架置入术未能改善病程。患者发展为象皮肿和进行性腹膜后纤维化，导致右肾孤立且需肾造瘘。泌尿外科医生应了解丝虫病的首发表现及其相关的泌尿系统并发症，特别是在病因不明的成年旅行者中，这些患者存在肾功能损害和不育问题。
