Painful haematuria following central venous catheter infection.

A 55-year-old female presented with gross haematuria and low back pain. Her previous medical history included type 2 diabetes mellitus and hypertension for more than 10 years. Two months earlier, she had undergone left lobectomy of the liver for intrahepatic duct stones. The post-operative course was complicated by methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia associated with central venous catheter infection. The catheter was removed, and treatment with intravenous vancomycin was begun. Her fever gradually subsided after a 2-week course of antibiotic therapy. Cardiac auscultation did not reveal a changing murmur. Repeated blood cultures were sterile. However, she began to notice gross haematuria and low back pain with radiation to the anterior thigh of her right leg, causing her to lie with her hips flexed. Based on her past history of degenerative spine disease, non-steroidal anti-inflammatory drugs (NSAIDs) were administered for pain relief, but the response was poor. Her white cell count was 14 400uml, with 78% neutrophils, her haematocrit was 39.9% and her platelet count was 362 000uml. Coagulation studies, renal function tests, antinuclear antibody, hepatitis B and C serologies, ASLO, and complement C3 and C4 were all normal. Urinalysis showed 11–20 white cells and 4q red cells per high-power field and was 100 mgudl for protein; no erythrocyte cast was found. Urine cultures and cytology studies were negative. Analysis of urinary red cell morphology revealed 51% dysmorphic erythrocytes, suggestive of intermediate haematuria. Plain abdominal radiograph was negative for urinary stones. Renal ultrasound and intravenous urography (IVU) were unremarkable. Her backache gradually worsened. Her haematuria remained unexplained. A nephrologist was asked to see the patient for her haematuria.