Hematuria in a 13-year-old Boy

Margaret A. Singer; Ashton Chen; Avinash Shetty; Steve Hodges

doi:10.1542/pir.2019-0044

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Margaret A. Singer, MD*
Ashton Chen, DO^†
Avinash Shetty, MD^†
Steve Hodges, MD^‡

^*University of Minnesota
^†Department of Pediatrics,
^‡Department of Urology, Wake Forest University Medical Center, Winston-Salem, NC

Address correspondence to Ashton Chen, DO, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: achen{at}wakehealth.edu

AUTHOR DISCLOSURE
Drs Singer, Chen, Shetty, and Hodges have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial produce/device.

Editorial Commentary

This is a fascinating case report that demonstrates findings and treatment of urinary schistosomiasis while also revealing variations in patient care across varying settings. In the United States, this child received what the authors describe as “gold standard” care—involving a diagnostic surgical procedure and multiple visits with multiple subspecialists. If this child had stayed in Mali, he most certainly would have had received a clinical diagnosis of schistosomiasis and effective treatment with oral praziquantel—without any diagnostic testing. Outside of the endemic area, some reasonable clinicians would still have treated presumptively, and others would have opted for treatment based on symptoms and serologic confirmation of schistomal infection, realizing, as the authors point out, that positive serology alone does not prove an active infection. Still, other clinicians might have opted to test multiple concentrated urine samples (especially the urine produced at the end of voiding) without a surgical search for the definitive diagnosis. All readers of Index of Suspicion can learn from this case and then decide how best to implement diagnostic and therapeutic interventions in their own settings based on careful analysis of the various risks and benefits.

Phil Fischer, Former Section Editor, Index of Suspicion

Presentation

A 13-year-old boy presents with a 7-year history of recurrent, gross hematuria. Referred by his pediatrician, he is being evaluated by a pediatric nephrologist. Each episode of hematuria, which he experiences about every 2 months, occurs mid-urine stream and without associated dysuria, fever, or abdominal pain. He is under guardianship of …