Atypical presentation of a renal tumor with pyelonephritis and deep vein thrombosis in the lower limb. Case report
Keywords:
case reports, differential diagnosis, pyelonephritis, renal cell carcinoma, urinary tract infections, venous thrombosisAbstract
Introduction: renal tumors with atypical presentations—such as severe urinary infections or thromboembolic complications—are uncommon, and their symptoms resemble those of other diseases, which poses diagnostic challenges for specialists.
Objective: to present a patient diagnosed with a renal tumor with atypical manifestations (pyelonephritis and deep venous thrombosis in a lower limb), emphasizing the difficulty of diagnosis due to overlapping symptoms.
Case presentation: a 60-year-old black male patient, with no comorbidities. Three days prior to consultation, he developed general malaise, fever of 38–39 °C, chills, moderate lumbar pain, and temperature changes, along with increased volume and pain in the right leg. Physical examination revealed positive posterior costovertebral angle tenderness and percussion pain, with no palpable masses, dysuria, or hematuria. In the right leg, the femoral, popliteal, dorsalis pedis, and posterior tibial pulses were present. He was diagnosed with renal cell carcinoma with vascular compression and was admitted. The urine culture tested positive, and Doppler ultrasound confirmed deep venous thrombosis. He was treated with antibiotics and anticoagulants; the infection resolved and the edema decreased. He declined surgical intervention; therefore, continued follow-up by the oncologist was maintained.
Conclusions: this report provides scientific evidence on the interaction between oncologic disease, infection, and vascular symptoms; this unusual scenario carries critical prognostic implications. Hence the importance of considering broad differential diagnoses in patients with atypical findings, as well as ensuring multidisciplinary care.
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