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Anterolateral intervertebral disc herniation presenting as visceral pain in a patient with renal keratinising desquamative squamous metaplasia
  1. Andrew S Bennett1,
  2. Caitlin Mcauliffe Gray1,
  3. Rupam Ruchi2 and
  4. Sanjeev Kumar1
  1. 1Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
  2. 2Department of Medicine/Nephrology, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Sanjeev Kumar; SKumar{at}


We report the case of a 70-year-old man who presented to the clinic with back pain and presumed chronic kidney pain from renal keratinising desquamative squamous metaplasia, in which he would intermittently pass keratin plugs in urine. The pain had a visceral-sounding component that was inconsistent with renal colic. MRI of the spine revealed anterolateral disc bulges, which were likely irritating the anterolateral sympathetic nerves of the intervertebral disc, mimicking visceral pain. Transforaminal epidural steroid injection (TFESI) was performed at the levels of the disc bulges. He had no pain during passage of keratin plugs for 6.5 months after the TFESI which could be attributed to the expected duration of symptoms relief after a properly done TFESI.

  • pain
  • renal system
  • pain (neurology)
  • drugs: musculoskeletal and joint diseases

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  • Contributors ASB: prepared the initial draft. CMG: procured the images, marked and captioned the figures. Helped prepare the initial draft. RR and SK: were the attending nephrologist and pain medicine specialist, respectively, on this case who reviewed and revised the manuscript for critically important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.