A 47-year-old man with chronic depression and tonic-clonic seizures, being prescribed paroxetine, maprotiline, lorazepam, and lamotrigine, presented with intense psychomotor agitation that was treated with propofol. Twenty-four hours later, a green-colored urine was observed (Fig. 1⇓ ). A diagnosis of acute porphyria was considered. The green urine showed red fluorescence when irradiated under ultraviolet light and Hoesch test was positive for porphobilinogen screening. Precursor and porphyrin concentrations in a 24-h urine were within reference limits.
- What are the most frequent causes of green discoloration of urine?
- When porphyrins are present in large amounts, what is the most likely color of urine?
- What interfering compounds can cause a false-positive Hoesch test result?
- What is the likely cause for the green urine in this patient?
Read the article here for the answers.