Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.
Background
A 60-year-old woman is referred to the emergency department because of a recent event of painless macroscopic hematuria. She reports having experienced several similar episodes during the past year, all of which spontaneously resolved. She regards these episodes as being of gynecologic origin because she is 5 years postmenopausal.
She describes a general feeling of malaise in the days preceding the current episode but denies having any fever, dysuria, or increased frequency or urgency of urination. The patient also describes an unintentional weight loss of 11 lb (5 kg) during the past 2 years.
The patient's medical history includes hypothyroidism that was treated medically with thyroxine. Her surgical history includes two treatments of dilatation and curettage and a tonsillectomy.
She has no known drug or food allergies, and she denies smoking, drug use, or alcohol consumption. She has no history of kidney stones or recurrent urinary tract infections.
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Cite this: Painless Bloody Urination in a 60-Year-Old Woman - Medscape - Apr 14, 2015.
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