As part of a medical mission, you see a 35 year old man in rural Egypt who tells you that his chief complaint is the presence of yellow urine while urinating. For all of his life, his urine has been brown/red, as has been the case for all of his  family members. Recently he was ill and hospitalized for cholecystitis, and was told during this admission that in addition to his infected gallbladder, he also had a ‘urine infection’ for which he was given a single days worth of oral pills.

A few days later, his urine turned from brown/red, to yellow. This frightened him, and therefore he came to you to seek help. Urine dipstick shows trace blood only. His CBC was within normal limits. Vitals were normal as well. He had no fevers, abdominal pain, weight loss or rashes on exam. He often bathes in the river, has interactions with many stray animals but has not had any animal bites or scratches. He has numerous insect bites on his legs and hands. He eats local food, obtained from the local market.

What is the most likely explanation for the ‘yellowing’ of his urine, and what would you tell the patient with regards to what is going on?

1. Fungal infection
2. Parasitic Infection
3. Bacterial Infection
4. Viral Infection
5. Autoimmune Disorder

Answer will be posted next week!