Dr. Coetzer presented a fascinating case of an immunocompromised man with history of renal transplantation who presented with fever, acute onset hematuria and flank pain.
We walked through an anatomical diagnostic schema for hematuria before we dived into our HPI questions
His UA had >1000 RBC, 9 WBC, no protein, no casts, no dysmorphic RBC’s. The patient had a CT without contrast that was not suggestive of nephrolithiasis or masses and the allograft appeared normal. There were no significant occupational exposures or culprit medications.
Given his immunocompromised state, infectious workup included EBV, CMV, quantiferon TB , Brucella antibodies, coccioides antibodies, urine Histoplasma antibodies, ureoplasma, mycoplasma, blood and urine cultures, all of which were negative. Adenovirus viral load was found to be >590,000,000 by PCR, consistent with adenovirus hemorrhagic cystitis (AHC).
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