It wasn’t that long ago that I had a patient who came to see me about his kidney stones. He looked sick and was clearly in a fair amount of discomfort, complaining of flank pain just like the kind he had experienced about a year earlier when he was first diagnosed. But the more he talked, the more things didn’t add up.

For starters, there was no blood in his urine specimen which I was expecting to see from the irritation of the stone. But his urine was normal. Okay, time for more questions.

Yes, he said, the symptoms now were exactly the same as the symptoms he had when he was first diagnosed – left flank pain.

But he had a fever and complained of fatigue – exhaustion really. Plus the pain was unrelenting – it wasn’t intermittent as I would have expected with kidney stones.

Hmmm, kidney infection? That would explain the fever and the pain. I could make the fatigue fit into the symptoms of a kidney infection, but exhaustion? But if it was a kidney infection, why was the urine normal? So I ordered blood work, sent the urine out for further analysis and ordered a CT scan in the hopes that these tests would tell me more.

And it sure did. He didn’t have kidney stones – he had a right lower lobe pneumonia. That certainly explained the fever and exhaustion. So why the left flank pain? Well, he certainly wasn’t trying to mislead me but I think he convinced himself that he had kidney stones and as sometimes we all do, he tried to make the symptoms fit his expectations. 

It was a powerful reminder to keep an open mind when trying to make sense of symtoms that don’t add up.

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