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 Table of Contents  
CLINICAL IMAGES
Year : 2021  |  Volume : 2  |  Issue : 2  |  Page : 187-188

Jack stone: When the urologist finds a SARS-CoV-2 virus look alike in the bladder!


1 Department of Urology, AIIMS, Rishikesh, Uttarakhand, India
2 Department of Surgical Gastroenterology, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission30-Nov-2020
Date of Decision15-May-2021
Date of Acceptance22-May-2021
Date of Web Publication30-Aug-2021

Correspondence Address:
Dr. Tushar Aditya Narain
Department of Urology, AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_193_20

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How to cite this article:
Ranjan SK, Ghorai RP, Narain TA, Dhar P, Mandal AK. Jack stone: When the urologist finds a SARS-CoV-2 virus look alike in the bladder!. J Med Evid 2021;2:187-8

How to cite this URL:
Ranjan SK, Ghorai RP, Narain TA, Dhar P, Mandal AK. Jack stone: When the urologist finds a SARS-CoV-2 virus look alike in the bladder!. J Med Evid [serial online] 2021 [cited 2021 Sep 25];2:187-8. Available from: http://www.journaljme.org/text.asp?2021/2/2/187/324957




  Description Top


Lower urinary tract calculi are frequently found in the bladder but also have been reported in the urethra, prostate and prepuce. The bladder calculi account for about 5% of urinary stone burden and approximately 1%–2% of them are associated with bladder outlet obstruction (BOO).[1] Here, we share an interesting clinical image of bladder stone mimicking the shape of SARS-CoV-2 virus with spicules.

A 68-year-old man presented with severe lower urinary tract symptoms, burning micturition and fever for 2 days. On evaluation, his International Prostate Symptom Score was 18 out of 35, encompassing both voiding and storage symptoms. The prostate was palpably enlarged on digital rectal examination. He was empirically started on levofloxacin and silodosin in view of benign prostatic hyperplasia (BPH) with urinary tract infection. Ultrasonography of the prostate revealed an enlarged prostate with a volume of 68 cc and an enlarged median lobe. A calculus of size 8 mm was also found in the bladder. X-ray and computed tomography of the kidney, ureter and bladder reiterated the findings of the ultrasound and confirmed the presence of a vesical calculus [Figure 1]. The urine culture did not reveal any growth. The patient was counselled for endoscopic stone clearance with transurethral resection of prostate, in view of the enlarged prostate causing urinary stasis resulting in lithiasis, but he opted for stone clearance only. On endoscopic evaluation, a calculus of size one centimetre was found in the bladder. The stone was characteristically brown-black with multiple spikes over it [Figure 1]. The tip of the spikes was green in colour, mimicking the exact shape of the SARS-CoV-2 virus. No organism was grown after the bacterial and fungal culture of the stone. After stone clearance, the patient was again evaluated for BOO and silodosin was continued. At present, he is asymptomatic on alpha-blocker for BPH. On chemical analysis of the retrieved stone, calcium and oxalate were the main constituents. This type of stone was previously described as jack stone or jackfruit stone because of the characteristic spikes like those in the jack toys or jackfruit [Figure 2].[2] At present, the world is suffering from the COVID-19 pandemic caused by coronavirus. The coronavirus is a single-stranded RNA virus covered in an envelope. On electron microscopy, the virus looks like having a crown or projections from the envelop hence the name coronavirus (coronum in Latin means crown).[3] Owing to the gross resemblance of this jack stone with the SARS-CoV-2 virus, it would be apt to rechristen the jack stone as the 'COVID stone', as a mark to the global pandemic, the whole world is facing and fighting [Figure 1] and [Figure 2].
Figure 1: A 68-year-old man presented with lower urinary tract symptom; (a) Coronal section of computed tomography scan showing a calculus of size 8 mm × 7 mm in the bladder with irregular margins (red arrow), (b) enlarge prostate protruding in the bladder (red arrow) (c) endoscopic view of stone in the bladder with characteristic spikes (jack stone), (d) fragments of stone retrieved after endoscopic lithotripsy

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Figure 2: (a) Axial section of computed tomography scan showing calculus in the urinary bladder, (b) calcium oxalate stone in the bladder (jack stone), the spikes of jack stone resembling with (c) coronavirus and (d) jackfruit spikes

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Douenias R, Rich M, Badlani G, Mazor D, Smith A. Predisposing factors in bladder calculi. Review of 100 cases. Urology 1991;37:240-3.  Back to cited text no. 1
    
2.
Singh KJ, Tiwari A, Goyal A. Jackstone: A rare entity of vesical calculus. Indian J Urol 2011;27:543-4.  Back to cited text no. 2
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3.
Tyrrell DA, Myint SH. Coronaviruses. In: Baron S, editor. Medical Microbiology. 4th ed., Ch. 60. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.  Back to cited text no. 3
    


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