The patient perched on the corner of the exam table. He stood up gingerly, a snap and crackle underlying his every move. An younger man, his delicacy was premature, the cautious movements of a man twice his age. His eyes could have used a good cleaning, the whites anything but. Grey orbs with a brown center, he looked at us nonchalantly, a cup of fresh urine in his hand.
The doctor takes the cup, places it on the table, and tells me to keep an eye on it. Nonplussed, I examine the urine, looking for the typical marks of illness. It wasn't cloudy, or discolored. It didn't smell sweet, or musty. I saw no crystals, no blood. So I looked away, taking in the interview, wondering what the doctor thought was going to happen.
After the final reflex hammer falls, the doctor looks up at me, asking for a diagnosis. The only thing I noticed was arthritis, the reason for his care in movement. Gambling, I toss out rheumatoid arthritis, and receive for my trouble a slow shake of the head, and an extended arm pointed at the cup of urine, now sitting there rather dark shade of black.
The patient had alkaptonuria, a fairly benign metabolic disease, a failure of tyrosine metabolism. His buildup of homogentisic acid has stained his connective tissue, darkening his eyes and causing pain in his joints. He eliminates it in the urine, and on exposure to air, it turns itself black.
As diseases go, its a fairly innocuous one to be stuck with. Unless you are the guy at the urinal next to him.
No comments:
Post a Comment