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[Intermittent chyluria in a young man]

A M Stanzial1, C Menini, M Casaril

  • 1Istituto di Patologia Medica, Policlinico Borgo Roma, Verona, Italia.

Presse Medicale (Paris, France : 1983)
|February 3, 1996
PubMed
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Chyluria, or milky urine, is a rare condition often caused by infection or trauma. This case highlights a potential link between chyluria and congenital malformations in a young man.

Area of Science:

  • Urology
  • Nephrology
  • Lymphology

Background:

  • Chyluria is a rare condition characterized by the passage of chylus (lymphatic fluid) into the urine, resulting from abnormal connections between the lymphatic and urinary systems.
  • Common etiologies include filariasis, trauma, neoplasia, and congenital malformations. However, idiopathic cases occur, presenting diagnostic challenges.

Observation:

  • A case study of an 18-year-old male presenting with milky urine following angiography after minor leg trauma.
  • Clinical findings included facial asymmetry, cutaneous dyschromia, hypogammaglobulinemia, an altered CD4/CD8 ratio, and significant lipiduria.
  • Diagnostic imaging, including CT and urography, was normal, but cystoscopy and selective catheterization localized the origin to the right ureter.

Findings:

  • Lymphography revealed a dilated lymphatic network with lacunar images near the right kidney, suggesting a lymphatic abnormality.

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  • The patient experienced recurrent episodes of chyluria over two years, which spontaneously resolved, indicating a dynamic or intermittent lymphatic leakage.
  • Despite the absence of typical etiological factors like filariasis, the constellation of symptoms pointed towards underlying multiple congenital malformations.

    • Implications:

    • This case suggests that congenital malformations, even without typical risk factors, should be considered in the differential diagnosis of chyluria.
    • The findings underscore the complexity of lymphatic-urinary fistulas and the need for thorough investigation in unexplained cases.
    • Further research into the specific mechanisms linking congenital anomalies to lymphatic system dysfunction in chyluria is warranted.