A 12-year-old boy complained of left flank swelling for the last 3 months. Three days before admission, he started to experience pain in his left flank, which was associated with high-grade fever, chills, rigour, and vomiting. At the time, he had no urinary or respiratory symptoms. Maternal pregnancy course and medical history were non-contributory, and he had an attended birth at a health centre; his past medical history was unremarkable. He has seven siblings, none of whom had similar symptoms. His mother had no history of radiation exposure, use of traditional medicine, or chemotherapy during pregnancy.
Examination
No dysmorphisms were noted in his general appearance. His vital signs were: pulse rate (PR) 142 beats/min, respiratory rate (RR) 33 breaths/min, temperature (T) 38.5 °C, and blood pressure (BP) 105/65 mmHg. Anthropometric measurements showed severe stunting. An abdominal examination revealed a distended abdomen, asymmetric with bulging left flank, visible horizontal line, upward umbilical slit, and absent rectus abdominis muscles. His abdomen was soft with a tender cystic, bimanually palpable mass on the left flank measuring 13 × 11 cm. Both testes were undescended. He also had scoliosis and developmental dysplasia of the hips with a waddling gait.
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