Lyme disease also called ,,the illness with a thousand faces" ("The Great Imitator") because it may mimic very well the symptoms and signs of other diseases, is an unusual medical encounter for the urologist. Every patient with Lyme disease has his own clinical feature, while the superposition over an unknown but easy to discover urological disease may lead to a misdiagnosis.
Case presentation: Male patient A. P. was an emergency transfer in our clinic with multiple system organ failure. The mirage of first imaging finding, bilateral obstructive ureteral calculi was obviated after the serological confirmation of Lyme disease suspected after the thorough history obtained from his family. The intensive care treatment, broad-spectrum antibiotics and hemodialysis sessions, together with external urinary drainage, lead to the improvement of the patient status, and subsequent proper urological treatment to urolithiasis cure.
Conclusions: This case identifies several challenges faced by practitioners, challenges which involve the diagnosis and the treatment of Lyme disease associated with urolithiasis. Although Lyme disease remains a controversial clinical entity, its diagnosis is based on a history of possible exposure to ticks, the appearance of specific clinical symptoms, whether or not combined with serological tests.