WILSON’S DISEASE PRESENTING WITH NEUROPSYCHIATRIC SYMPTOMS AND KAYSER–FLEISCHER RING COMPLICATED BY URETERIC CALCULUS AND UTI

Abstract

Background: Wilson’s disease is an autosomal recessive disorder of copper metabolism leading to toxic accumulation in multiple organs, most prominently the liver, brain, and cornea. While neuropsychiatric manifestations and Kayser–Fleischer (KF) rings are well-established diagnostic hallmarks, renal complications such as nephrolithiasis and secondary urinary tract infection (UTI) are less frequently recognised, despite their potential to significantly alter clinical outcomes.

Case Presentation: We report the case of a 25-year-old male with known Wilson’s disease who presented with progressive memory impairment, behavioural dullness, tremors, and bradykinesia over several months. Slit-lamp examination revealed a distinct KF ring, indicating ongoing systemic copper deposition, corroborated by markedly reduced ceruloplasmin levels. Following a transient neurological exacerbation, the patient later developed acute flank pain, low-grade fever, and anorexia. Ultrasound imaging identified a lower calyceal renal calculus and a distal ureteric calculus causing mild hydroureteronephrosis. Urinalysis demonstrated early features of UTI. He was managed conservatively with intravenous antibiotics, hydration, analgesics, and continuation of chelation and dopaminergic therapy, resulting in rapid symptom resolution and stable renal and neurological status.

Conclusion: This case highlights the multisystemic nature of Wilson’s disease, emphasising the need for vigilance regarding renal complications, particularly when new-onset pain or fever emerges in patients presenting primarily with neurological involvement.