CHYLURIA WITH REMISSION IN A YOUNG MAN

Chyluria is the passage of chylus into urine resulting in fistulizatio n through the lymphatic system and the urinary system. This rare condi tion is usually caused by filaria infestation or malformations, neopla sia or trauma, We report a case of a 18-year-old man. The patient pres ented milky urine which had appeared after angiography following minor leg trauma, Physical examination revealed asymmetry of the face and c utaneous dyschromia, Blood tests revealed hypogammaglobulinemia and al tered CD4/CD8 ratio (0.6), Urine tests showed proteinuria (30 mg/dl), lipiduria (triglycerides 750 mg/dl) and density of 1025, Renal functio n was normal, Abdomen computed tomography and urography were normal, C ystoscopy revealed the presence of milky urine in the bladder and sele ctive catheterization revealed that the origin was the right ureter al one. Ascendent pyelography did not reveal any malformation of the urin ary tract; but after this the chyluria spontaneously disappeared. The patient was rehospitalized 3 months later for recurrence, Lymphography was then performed and revealed a dilated lymphatic network with minu te lacunar images projecting into the right kidney. Chyluria again dis appeared spontaneously and recurred sporadically over the next two yea rs in a patient who remained in good physical condition. The etiology of chyluria in a patient without filaria infestation is problematic, p articularly when the most common causes (tuberculosis, neoplasia, trau ma) are excluded as in our case. The asymmetry of the face, together w ith cutaneous dyschromia and the presence of a subarachnoidea cyst in the right temporal region suggested our patient had multiple congenita l malformations.