ABSTRACT
Introduction@#Dioctophyma renale, also known as the “giant kidney” worm is the largest nematode that infects mammals. Most commonly, it infects dogs and only a few cases of human infestation have been reported.@*Case Presentation@#In this case, we present a 71-year-old male with a history of right flank pain, painless hematuria, obstructive urinary symptoms and occasional passage of a long red meat-like structure via urethra. Previous ultrasonography revealed a renal mass that was interpreted as renal malignancy. Patient was advised radical nephrectomy with biopsy; however, he was lost to follow up. After 8 years, he again presented with a 2-month history of right flank pain, gross hematuria, unintentional weight loss and obstructive urinary symptoms. He was admitted to our institution and laboratory findings revealed microcytic hypochromic anemia. Ultrasound showed a focal bulge in the superior wall of the urinary bladder and an enlarged right kidney with a large heterogeneous solid structure. Insertion of a foley catheter relieved the urinary obstruction and there was noted passage of a single roundworm measuring 55 cm by 0.32 cm. The specimen was sent for histopathology and microscopic examination revealed a necrotic body of a roundworm consistent with Dioctophyma renale.@*Case Discussion@#The clinical manifestations of D. renale infection are non-specific and the diagnosis can be a challenge as it commonly mimics renal malignancy and other intra-abdominal tumors. The diagnosis is often an incidental finding of the parasite on necropsy or by finding ova in the urine. The clinical findings of painless hematuria, unintentional weight loss and an ultrasound finding of renal mass usually point toward the diagnosis of renal cell carcinoma. As we present this case, it will be highlighted that such signs and symptoms, such as painless hematuria, unintentional weight loss and ultrasound finding of a renal mass, can also be found in patients with rare human parasitism from Dioctophyma renale.