title: Repetitive reddish discoloration of urine in a female adolescent following short-distance walking on a smooth road: Questions.
abstract: A previously healthy 15-year-old girl was evaluated following five episodes of reddish urine discoloration after walking for approximately 30 min on a smooth roadway. In each episode, the discoloration lasted for four to five urinations and followed by normal urine dipstick tests. No other exercise-produced urine discoloration and no other symptoms were reported. Laboratory evaluation during the episodes revealed a reddish urine sample with 3+ hemoglobin/myoglobin and absence of hematuria. Full blood count, serum creatinine, liver function tests, and electrolyte levels were all within normal limits. Myoglobulinuria was excluded, since muscle enzymes were within normal limits. Blood smear analysis showed mild anisopoikilocytosis with stomatocytes and ovalocytes, leading to extended evaluation for erythrocyte disorders. This case is interesting in that the hemoglobinuria occurred after mild walking and was accompanied by erythrocyte morphological changes. This quiz discusses the differential diagnosis of hemoglobinuria with particular reference to the conditions of appearance (after walking) and emphasizes the importance of step-by-step investigations to reach a definitive diagnosis.
authors.affiliation: Department of Pediatrics, Ioannina University Hospital, Stavros Niarchos Avenue, 45 500, Ioannina, Greece. eksiomou@yahoo.gr.
authors.forename: Ekaterini
authors.identifier: http://orcid.org/0000-0002-0032-9047
authors.initials: E
authors.lastname: Siomou
authors.affiliation: Department of Pediatrics, Ioannina University Hospital, Stavros Niarchos Avenue, 45 500, Ioannina, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Baziou
authors.affiliation: Hematology Laboratory, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Evagelos
authors.initials: E
authors.lastname: Premetis
authors.affiliation: Oncohematology Unit, Physiopathology of Anemias Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Vercellati
authors.affiliation: Department of Pediatrics, Ioannina University Hospital, Stavros Niarchos Avenue, 45 500, Ioannina, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Chaliasos
authors.affiliation: Department of Pediatrics, Ioannina University Hospital, Stavros Niarchos Avenue, 45 500, Ioannina, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Makis
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D006454:Hemoglobins; D006456:Hemoglobinuria / Q000175:diagnosis*; D006801:Humans; D014556:Urine / Q000737:chemistry*; D016138:Walking
chemical_list: D006454:Hemoglobins
keywords: Adolescent; Child; Reddish urine; Walking