A Mail Carrier With Gross Hematuria Whose Sister Has Lupus

Paige A. Hargis, BS; Katie S. Murray, DO, MS


October 12, 2021

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 that you would like to suggest for a future Case Challenge, please contact us.


A 60-year-old man presents to his primary care physician with a 2-week history of gross hematuria. He has had no recent illness or exposure to sick contacts. He reports no fever or chills, shortness of breath, abdominal or flank pain, diarrhea or constipation, nausea or vomiting, fatigue, weight loss, lightheadedness, or weakness. He also denies urinary tract symptoms, including dysuria, frequency, urgency, weak stream, and incomplete emptying.

His past medical history is significant for rheumatic fever, mitral valve replacement, and lifelong anticoagulation with warfarin. Otherwise, he states that he is relatively healthy. He missed his most recent appointment with his cardiologist but plans to see him in 2 weeks for follow-up.

The patient is married and works as a mail carrier. He has a 15–pack-year smoking history, although he quit more than 10 years ago. He does not consume alcohol or use illicit drugs. His father received a diagnosis of prostate cancer in his 80s, and his sister recently received a diagnosis of lupus.


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