We have a new record: 80 years from publication to retraction

We have a new record for the longest time from publication to retraction: 80 years. It’s for a case report about a 24-year-old man who died after coughing up more than four cups of what apparently looked — and smelled — like pee.

According to the case report titled “Een geval van uroptoë” published in 1923, an autopsy revealed that the man had a kidney that was strangely located in his chest cavity. A case of pneumonia caused the kidney to leak urine into the space around his lungs, leading to the perplexing cough.

If that sounds too crazy to be true, you’re right: This man never existed. The case was retracted in 2003. (Yes, we are a little late to this one — it recently popped up in one of our Google alerts.)

A write-up by the editors of the Nederlands Tijdschrift voor Geneeskunde — that translates to “Dutch Journal of Medicine” — explains that the strange case was a fake (on the fifth page of this PDF, in English):

Clinical reasoning and decision making in practice. A man with pneumonia and ill-smelling watery sputum; the truth revealed after 80 years. – A 24-year-old man was admitted to hospital with pneumonia. On admission he was seen to have an asymmetrical build. During treatment of the lung infiltrate his clinical condition deteriorated. On the third day he coughed up great quantities of fluid which had a urine-like smell. The concentration of creatinine in this fluid was the same as in urine. On X-ray of the thorax, a massive accumulation of pleural fluid was seen. Shortly after aspiration of 1000 ml of pleural fluid the patient died. At autopsy, an ectopic kidney was found in the left thoracic cavity. The pneumonia had caused an abscess that had broken into the pelvis of this ectopic kidney causing the loss of urine into the pleural cavity (urothorax) and ‘uroptysis’. On the basis of anatomical and embryological aspects it is debatable if this case was genuine. It is in fact a duplication of a case report published in this journal in 1923 the reliability of which was never clarified. Biographical information from Professor A. Querido (1901-1983) which has since become available indicates that the case was faked by mischievous medical students preparing for their examinations. They had never imagined that the editors might actually accept it for publication. The case report of 1923 has now been retracted.

It’s not clear whether this is the official retraction notice — we’ve also found this page on the NTVG website that appears to retract the paper (according to our Google Translated version):

An article in this issue clearly show that the article H.van der Speck, published in this magazine in 1923, is a fictitious patient. It is unlikely that the magazine under the editorship of former prof.dr.G.van Rijnberk had a peer review system as we know it since a few decades.

In a commentary published along with the retraction (translated into English by One Hour Translation), the editors of the journal explain how the faked case came to light. Specifically, one editor decided to look up the class, thinking it was “commonly known” to be fabricated.

Taking this as a starting point, we thought it would be worth the effort to see if there were any references to this article in later editions of the Magazine and specifically to see if there was an official retraction of said article, which is usually done in case it’s clear that an article is based on a fabricated case.

They looked for a retraction note, but couldn’t find one.

And it wasn’t clear to everyone that the case was fake, they write:

Some of the experts that were asked to diagnose the medical history seemed to be in doubt: even though the case seemed improbable, it was not deemed impossible.

The editors found the definitive answer about the truth of the case in the autobiography of someone named Prof. Dr. A. Querido (1901-1983), emeritus professor of social medicine at the University of Amsterdam, who was a medical student in 1923. He and some of the students had some down time after they had finished studying for an exam, and so turned to hypothetical medical conditions:

Taking it easy at the start, but growing more enthusiastic as time went on, we started to make up diseases and forms of illnesses: “If one was suffering from this disease, what would be the symptoms?”

“If kidney growth (Mesonephros) continued to exist due to an embryological error”, said one of them, “you would see a working kidney across the spine, into the thorax.”

“Indeed”, said another, “that side would then have to lack a testis, because the mesonephros forms the efferent ductules of the testis.”

“That’s right”, said a third, “and if that half-man suffers from a lung infection, the infection spread into the primitive renal pelvis, resulting in the patient suffering from…”

“Piss cough.”

The students decided to try to get this made-up case published:

We forgot our exam – nothing could be more important – and developed the strategy required to get our brilliant idea published. It quickly became evident that this case could not take place in the Netherlands, because when mentioning a single name our plot would be uncovered. Thankfully we still had our colonies. The East Indies was deemed as the country of origin, which was made easier as one of your group members came from Indonesia and still knew people over there.

The students never believed the fake report would actually be published:

We contemplated adding an image of the primal kidney by way of a picture of a Gelderse sausage, but we felt this would go too far. We didn’t actually believe that someone working for the Magazine, would fall for this ploy. We felt that we had built in enough clear indications that would show the implausibility of the story. For instance, the laboratory test, that proved the existing of urine in the saliva, was fabricated. The female characteristics on one side of the body was clear nonsense.

So in 2003, the editors decided to officially retract the 1923 paper:

As this literature from the old days, has become as accessible as it has, it seems to be the right timing for an official retraction, which will, once and for all, make it clear that this case is fabricated.

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