Hematuria - Look beyond the Urinary Tract - A Rare Case Report

The major causes of hematuria in a middle-aged female include infections, renal calculi, or structural abnormalities of the urinary tract. Most patients are investigated and treated on an outpatient basis. While a possibility of malignancy of the bladder or kidneys may also be considered, hematological malignancy is an uncommon cause of hematuria. Detailed evaluation is important to rule out malignancy in new-onset hematuria. We report a case of a 49-year-old female who presented with gross hematuria, later diagnosed to have multiple myeloma (MM), despite the absence of its classical symptoms. This unusual presentation reaffirms its status as "The Great Masquerader." The case is worth highlighting because gross hematuria as the first presentation of MM is uncommon. The author wishes to stress that the clinician should also suspect blood dyscrasias with associated coagulation abnormalities in the workup of gross hematuria.