A 39-year-old woman comes to you complaining of lower abdominal pain which she has had for the past day. She left her job as a nurse's aide (her second day on the job) because the pain was so bad. She says the pain began after she had fallen off a stepstool while getting a bedpan off a top shelf. No one saw her fall, but she convinced her supervisor that she had an industrial accident and needed medical attention because of blood in her urine. To prove it, she brings in a urine specimen.

Questions:

1. How do you correlate the macroscopic and microscopic findings?

The macroscopic appearance is red, but the test for blood is negative and there are no RBC's microscopically. It is unlikely to be rhabdomyolysis. This specimen could be factitious. It would be a simple matter to have the patient produce another sample (though she might still be carrying the same bottle of red food coloring with her). Remember that various drugs can also produce colored urine. Eating fresh beets can colour the urine red temporarily.

2. What do you think is happening?

Although care and concern should be the immediate response of health care workers to a patient, and historical findings should be duly noted, remember that patients may not always be telling you everything, or telling you correctly, particularly when compensation is being sought.