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A Tale of Two Urines


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 – we must look at urine and stool specimens, blood smears,  microbiology plates… whatever we might have to  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 to  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

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