A previously healthy 54-year-old Japanese man reported chocolate-colored urine (Figure 1) and dysu- ria. He did not report fever or abdominal pain. His vital.
Journal of General and Family Medicine
2016, vol. 17, no. 3, p. 252–253.
Images in Clinical Medicine
Chocolate Colored Urine Kazuhiro Kamata, MD,1 Toshikazu Abe, MD, MPH,2 Hiroyuki Kabayashi, MD, PhD,3 and Yasuharu Tokuda, MD, MPH4 1
Department of Medicine, Tokyo Joto Hospital, Tokyo, Japan
2
Department of Emergency and Critical Care Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
3 4
Japan Community Healthcare Organization, Tokyo, Japan
Keywords: chocolate colored urine, infective endocarditis, culture negative, traumatic intravascular hemolysis
A previously healthy 54-year-old Japanese man
thoracic echocardiogram revealed mild mitral regur-
reported chocolate-colored urine (Figure 1) and dysuria. He did not report fever or abdominal pain. His vital
gitation without a vegetation. We administered ceftriaxone, initiated hemodialysis,
signs were normal, the bulbar conjunctiva was icteric,
and initiated plasma exchange for suspected thrombotic
and he had a loud low-pitched systolic murmur at the apex with no third or fourth heart sounds. There were
microangiopathy (TMA). Although his urine color gradually normalized (Figure 1), he developed severe
no peripheral stigmata of endocarditis. Laboratory data demonstrated a white blood cell count of 10,300/µL,
acute heart failure. A second transthoracic echocardiogram revealed severe mitral valve regurgitation and
hemoglobin 13.0 g/dl, platelet count 100,000/µL, CRP
tricuspid valve regurgitation but no vegetation. He
7.2 mg/dl, serum creatinine 4.7 mg/dl, indirect bilirubin 1.9 mg/dl, lactate dehydrogenase 2,109 IU/L
underwent a mitral valve replacement and tricuspid valve repair. A vegetation was detected on the posterior
(normal: 200–400 IU/L), haptoglobin
