Microfilaruria in a Patient of Chyluria

A 38-year-old man presented with a history of passage of milky urine for the past 6 months; he had lost weight but denied dysuria and fever. Physical examination showed a thin, malnourished man weighing 52 kg and no lymphadenopathy but mild bipedal pitting edema. Urine sample showed milky-appearing urine (Figure 1A). Urinalysis showed urinary triglycerides of 167 mg/dL against serum of 84 mg/dL, and 24-hour urinary proteins were 6.5 g. Centrifuged urine revealed sheathed microfilaria having a uniformly tapering caudal end with no terminal nuclei (Figure 1B and C). We provisionally diagnosed the case as chyluria with Wuchereria bancrofti microfilaruria. A Tc sulphur colloid lymphoscintigraphy revealed evidence of communication of the lymphatic system with upper ureter. Delayed radiotracer activity was seen in the urinary bladder (Figure 1D). The patient received diethylcarbamazine for 14 days without resolution of illness. A high-protein diet exclusive of all fats except medium-chain triglycerides (coconut oil) was initiated.