Djenkolism: case report and literature review
A 32-year-old man presented to our rural clinic in Borneo, Indonesia, with 10 hours of severe bilateral flank pain. Two hours after eating ten djenkol beans, the patient experienced acute, bilateral, severe (rated as 10/10), and spasmodic flank pain which radiated to the groin and was accompanied by vomiting. He also experienced difficulty with urination, hematuria, and decreased urine output (2 mL over the course of 12 hours).\nThe patient was healthy with no known medical problems. Medical history noted that the patient had experienced a similar episode as a teenager; he did not seek medical attention at that time and recovered after 14 days. The patient had consumed djenkol beans during the interval period between the two episodes without symptoms. He did not have any recent illnesses and had not taken medications prior to or since the onset of pain.\nThe patient was fully alert and in moderate distress. Vital signs were recorded at the time of treatment: blood pressure at 120/80; heart rate at 77 beats per minute; respiratory rate at 16 breaths per minute; and temperature at 36.5°C. The patient experienced approximately 2 minutes of severe spasmodic pain every 10 minutes with concurrent vomiting or syncope. Physical examination was notable for the odor of djenkol on his breath, abdominal hyperperistalsis, suprapubic tenderness, and bilateral costovertebral tenderness. Intravenous (IV) access was obtained and an indwelling urinary catheter was placed. The patient was given tramadol 50 mg IV for pain and urged to drink carbonated beverages as tolerated.\nAn ultrasound of the kidneys revealed bilateral hydronephrosis () with no stones noted. Anuria persisted and was treated with a 2.5 L normal saline bolus and furosemide 20 mg IV. The patient subsequently urinated 200 mL of bloody urine with resolution of pain. Upon microscopic exam, the initial urine sample had a specific gravity of 1.020 and 3+ blood, microscopic exam revealed many red blood cells and sediment but no crystals. The patient continued to receive pain medications and IV fluids as needed with resolution of oliguria.\nAfter four days, the patient’s other symptoms, including hematuria, resolved. A repeat ultrasound demonstrated mild right-sided hydronephrosis and a normal left kidney. The patient was discharged on tramadol as needed, encouraged to drink at least 2 L of fluid per day, and advised to avoid djenkol beans. The patient returned approximately 2 weeks later completely asymptomatic; residual right-sided hydronephrosis had also completely resolved.