Unrelenting lumbar pain in a female adolescent: Questions

Excerpt

A 13-year-old girl presented with an 11-day history of left lumbar and flank pain. The pain had started in association with mild dysuria and was increasing in intensity so that she needed continued analgesia with several drugs. She had been studied at her local hospital. Urinary tract infection and renal lithiasis had been ruled out. The patient was submitted to our unit for further explorations and difficulty in pain relief. She denied hematuria, fever, chills, weight loss, or gynecological complaints. She had nausea and vomiting, loss of appetite, and orthostatic hypotension. Past medical history was remarkable for asthma, repeated episodes of dysuria without confirmation of urinary tract infection, and dysmenorrhea. Four years before she had undergone a laparotomy for recurrent abdominal pain, intestinal bridles are the only significant finding. During early childhood, the patient grew up in an unfavorable social environment resulting from affective family problems. Family history included father with renal urolithiasis and mother with clinical depression. …