Abstract
A 64-year-old male patient, resident of Kochi prefecture where an endemic of filariasis had once happened, suffered from chyluria due to filariasis at the age of 29 and two incidences of hematochyluria at the age of 59 and 63. He visited neighbor hospital due to severe pain from herpes zoster in the left fourth cervical nerve area and was given prescription of anti-virus drug, nonsteroidal anti-inflammatory agents and oral dose of 75mg/day of amitriptyline. However, he suffered again from severe pain. He was then referred to our pain clinic department in order to relieve the pain. Stellate ganglion block and continuous cervical epidural block were performed and oral dose of 400mg/day of carbamazepine was administered simultaneously. These measures gradually reduced frequency, severity and duration of the pain, then it totally disappeared. However, sudden urinary retention occurred on the fifth hospital day. Urinalysis showed hematochyluria, including abundant white gelatinous contents and blood clots. Urethral catheterization was done several times because of catheter blockage due to recurrent hematochyluria. After administration of amitriptyline and carbamazepine was discontinued, hematochyluria gradually improved.
Filaria has already been eradicated in Japan, but chyluria still appears at chronic stage of filariasis. Parasitic hematochyluria is caused by the compression or obstruction of the lymphatic vessels and leakage of chylus into urine through the fistula with blood from the lymphatic vessels to the urinary system caused by parasitism of Wuchereria bancrofti. This case suggests the necessity of precautionary administration of anticholinergic drugs such as amitriptyline and carbamazepine to patients with filariasis because of the possibility of hematochyluria.
