Rare cause of bright red gross hematuria in a child
The present case has been reported in the Indian Journal of Nephrology. A 12-year-old male child reported with complaints of red-colored urine with fresh clots and generalized body aches of 3 days duration. There was no history of drug use, trauma, or bleeding from any other site.

A significant history included Burkitt Lymphoma, which was diagnosed at the age of 2 years elsewhere, and he was treated with chemotherapy (details not available). Subsequently, he developed ataxic gait and tremors from the age of 3 years. This was attributed to side effects of chemotherapy and not investigated further. He was bed ridden after that. There was a history of chronic redness of eyes and non-purulent discharge on and off. His clinical examination revealed a malnourished child with severe pallor.

He was normotensive and had normal renal functions and electrolytes. Complement levels were normal. He had severe anemia with reticulocytosis, and glucose-6-phosphate dehydrogenase enzyme was deficient. Coagulation profile was normal. Urine culture was sterile. There was no significant proteinuria. Hemoglobin electrophoresis was normal. Hypercalciuria was ruled out. He was transfused a unit of packed red blood cell. His gross hematuria with the passage of fresh clots of urine persisted. Renal ultrasound revealed normal renal sizes and there was echogenic debris in the bladder.

As there was fresh blood with clots, a possibility of an extra glomerular cause of bleeding was considered. MRI abdomen ruled out Wilms tumor. Since he had a history of inability to walk with non-purulent eye discharge and redness of eyes, a differential diagnosis of ataxia telangiectasia was kept. Alpha-fetoprotein was sent and found to be high.

His immunoglobulin profile revealed low IgG. MRI of the brain demonstrated cerebellar atrophy. The gross hematuria with clots persisted for 2 weeks requiring another blood transfusion. Cystoscopy was done and it revealed a telangiectatic vessels in bladder mucosa [Figure 1], and diathermy was done after which the bleeding stopped. On subsequent follow-ups, the child continues to have gross hematuria and has undergone 3 sessions of diathermy.

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