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Pseudohaematuria Due to Mesalazine: A Case Report
Mimi Truong1, Lukas Kairaitis2,3, Ronald L Castelino1,3
1School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Nephrology (Carlton, Vic.)
|January 15, 2025
Summary
Visible haematuria (blood in urine) can be alarming. A rare reaction between mesalazine and bleach causes red/brown urine, mimicking serious conditions and causing patient distress.
Area of Science:
- Nephrology
- Clinical Chemistry
- Urology
Background:
- Macroscopic haematuria often causes patient distress due to potential links with serious urinary tract conditions.
- Differential diagnosis for visible haematuria includes malignancy, infection, and glomerular disease.
- Mesalazine is a common medication for inflammatory bowel disease.
Observation:
- A 19-year-old female presented with red/brown urinary discolouration.
- The patient was taking mesalazine for inflammatory colitis.
- The discolouration was traced to a chemical reaction in the toilet bowl.
Findings:
- The red/brown urine resulted from a reaction between renally excreted mesalazine and domestic bleach.
- This chemical interaction mimicked the appearance of true haematuria.
- No underlying urinary tract pathology was identified.
Implications:
- Clinicians should consider this mesalazine-bleach interaction when evaluating patients with unexplained red/brown urine.
- Awareness can prevent unnecessary investigations and reduce patient anxiety.
- Educating patients on this potential interaction is crucial for accurate symptom reporting.
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