A healthy young girl with a pink specimen and a male teen whose urine is green. What's in your differential Dxs?
Over my years in working with residents, I have always impressed on them that we are all very much medical detectives. It is nice to use dermatology clues, but they are not always present.So, I always emphasize the holistic approach â we must look at urine and stool specimens, blood smears,Â microbiology platesâ¦ whatever we might have to Â assist us as we try to solve “mystery cases.”In recent times, however, performing our own lab tests is not allowed. I, being “old school,” have always had a microscope available in the office which allows me to provide some quick answers/additional clues. It is also advantageous to have the lab close by and to hav friendly lab techs who will invite you to come have a look at what they are seeing. This, I suggest, is the true art of medicine and reinforces learning. I often tell residents that “I am a PGY-XX” and that I will always be a student.This year I announce that “I am a PGY- 43 11/12” as I ignore the eye rolling and the “under the breath” snickering.And that brings us to today’s two medical mysteries as I invite you and a virtual resident toÂ reenact your version of Sherlock Holmes/Columbo.
Resources/Additional reading (alphabetical order)
Gupta D, Gupta R. Green urine. ScientificWorldJOURNAL. 2011;11: 1101–1102. https://www.researchgate.net/publication/51175592_Green_Urine
Koratala A, Leghrouz M. Green urine. Clin Case Rep. 2017;8:549-550. doi: 10.1002/ccr3.891. eCollection 2017 Apr.
La Manna A, Polito C, Marte A, et al. Hyperuricosuria in children: clinical presentation and natural history. Pediatrics. 2001; 107:
Prakash S, Saini S, Mullick P, Pawar M. Green urine: A cause for concern? J Anaesthesiol Clin Pharmacol. 2017;33:128-130. doi: 10.4103/0970-9185.202190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374818/
Raymond JR, Yarger WE. Abnormal urine color: differential diagnosis. South Med J. 1988;81:837-41. https://www.ncbi.nlm.nih.gov/pubmed/?term=Abnormal+Urine+Color%2C+Raymond+JR%2C+Yarger+WE%2C+South+Med+J