After entering the room, it is clear something unusual is going on. This previously healthy 27-year-old has large blood-filled blisters in her mouth. In front of her, she carries a basin into which she is continuously spitting up blood, saliva, and clots.
She had presented to another emergency department two days earlier with complaints of hematuria and flank pain. After a negative CT scan of her abdomen and pelvis, she was given a provisional diagnosis of urinary tract infection and hematuria and discharged home with a prescription for nitrofurantoin. Apart from the recently prescribed antibiotic, she denies any other medications or supplements.