Factitious Struvite Stones — A Case Report

Abstract

The patient to be described is a 30-year-old female hospital employee who had a three-year history of repeated hospital admissions with renal colic, hematuria, and apparent passage of 2–3 mm stones, analyzed as struvite. She had received numerous courses of intramuscular narcotics. Apart from tiny calcifications in the right kidney which were present at the time of the first attack, all subsequent x-ray and ultrasound examinations of the kidneys were negative. Metabolic investigations for causes of stones were negative and urine cultures were sterile. Because of the discrepancy between the apparent symptoms and the negative laboratory tests, the possibility of factitious disease was suspected. A search of the patient’s belongings yielded evidence that the ‘hematuria’ was being feigned, together with a plentiful supply of apparent renal calculi, analyzed as struvite plus calcium carbonate. Confronted with the evidence, the patient appeared somewhat relieved, and indicated the stones were of feline origin, collected from local veterinarians on the pretext of conducting research on cat stones. The motives for this subterfuge proved to be complex, but the patient has remained free of ‘recurrence’.