ID: This is a 56 yo M with history of hypertension and prior episodes of gross hematuria that presents with bloody urine for three days. In addition he has noticed clots in his urine, flank pain, constipation as well as decrease urine output. However, the patient denies dysuria, fevers, or weight loss. His exam demonstrates slight suprapubic pain but no other significant findings. Organomegaly was not appreciated but it was a difficult exam due to body habitus. Labs were significant for BUN/Cr: 26/1.65, Calcium 11, UA: large blood, >50 RBC/HPF with 100 protein and no RBC casts, and PTHrP 41. Given hypercalcemia secondary to elevated PTHrP and non-glomerular bleeding, suspicion for renal cell carcinoma is high. A CT urogram was pursued demonstrating necrotic right renal mass, involving the right renal vein and indeterminate involvement of the inferior vena cava.
Differentiate between glomerular and non-glomerular bleeding in hematuria cases
CC: 1 week of bloody, purulent urethral meatus discharge
ID: 32 yo Filipino male with history of prior sexual assault with subsequent recurrent UTIs, and newly diagnosed urethral stricture s/p suprapubic catheter placement presents with 1 week of bloody, purulent discharge from his urethral meatus. On exam, he was noted to have milky, bloody discharge from his meatus and fluctuant paratesticular masses in bilateral scrotum and base of the penis. Scrotal ultrasound revealed abscesses within bilateral scrotum and penis. He was taken to the OR for surgical exploration and abscess drainage. Pathology specimen was remarkable for caseating granulomatous inflammation with positive AFB stains in the peritesticular abscess fluid. Patient was ultimately diagnosed with genitourinary tuberculosis.
Pearls from morning report:
The differential for sterile pyuria is broad and includes TB, fungal organisms, urinary stone, interstitial cystitis, prostatitis, STIs and PID.
When evaluating acute scrotal pain, consider Prehn’s sign. A positive Prehn’s sign (alleviation of pain with scrotal elevation) indicates epididymitis, not testicular torsion.
LAC+USC is proud to diagnose and treat 1% of all tuberculosis cases nationwide. The earliest evidence of TB in men and animals was discovered in the form of fossils – spinal TB – dating back to 8000 BC.