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This open access case report presents an elderly patient with incidental blue-green urine, reviews plausible etiologies, and highlights how careful clinical history distinguishes benign explanations from serious pathologic causes for timely, targeted evaluation.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/diagnostic-approach-to-abnormal-urine-colors-lessons-from-a-case-of-blue-green-urine/565122/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/diagnostic-approach-to-abnormal-urine-colors-lessons-from-a-case-of-blue-green-urine/565122.png","ImageObject",442,249,{"name":88,"@type":89},"McQueen","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-21","2026-10-12",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Why can abnormal urine colors be difficult to interpret clinically?","Question",{"text":108,"@type":109},"Urine color changes can reflect systemic disease, metabolic or renal pathology, or benign iatrogenic causes, and patients may present with incidental findings that require careful context.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What causes blue-green urine according to the case report’s differential?",{"text":113,"@type":109},"The report describes iatrogenic, endogenous, and infectious causes, including drug effects (e.g., methylene blue) and organisms such as Pseudomonas aeruginosa, as well as metabolic conditions like alkaptonuria and Hartnup disease.",{"name":115,"@type":106,"acceptedAnswer":116},"What diagnostic tools are mentioned to narrow the cause of abnormal urine color?",{"text":117,"@type":109},"The report references dipstick urinalysis for semiquantitative clues (e.g., hematuria or bilirubinuria) and spectrophotometry for suspected metabolic disorders involving porphyrins or homogentisic acid.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},565122,1792525604,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":76},5909890329169,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 03/27/2025  \nReview ended 04/07/2025  \nPublished 04/11/2025  \n© Copyright 2025  \nBalen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.82122  \nOpen Access Case Report  \nDiagnostic Approach to Abnormal Urine Colors: Lessons From a Case of Blue-Green Urine  \nCarson Balen 1, Zayd Chishti 2, Jason W. Wilson 1  \n1. Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, USA 2. Medicine, University of South Florida Morsani College of Medicine, Tampa, USA  \nCorresponding author: Carson Balen, [hyuntae23@usf.edu](hyuntae23@usf.edu)  \nAbstract  \nAbnormal urine coloration can be a perplexing finding in clinical practice, often prompting concern among both patients and healthcare providers. While cases of red, brown, and yellow urine are more commonly encountered, blue-green urine remains a rare and under-researched phenomenon. This case report describesan elderly patient presenting with an incidental finding of blue-green urine, exploring its potential etiologies and emphasizing the importance of clinical history in identifying benign versus pathological causes.  \nCategories: Emergency Medicine, Urology, Pharmacology  \nKeywords: abnormal urine, abnormal urine color, blue-green urine, methylene blue treatment, urine color change  \nIntroduction  \nMedical professionals and lay people are often unsure how to interpret abnormal urine colors and whether an abnormality reflects a patient’s underlying health status. This case report reviews an incidental abnormal urine color finding in a patient who presented to the emergency department (ED), considers the likely cause of that patient’s abnormality, and reviews known causes of abnormal urine color.  \nUnder normal physiological conditions, urine varies in color from pale yellow to amber. This color is primarily due to urochrome, a pigment derived from the breakdown of hemoglobin [1] . Deviations from this hue may signal underlying systemic disease, metabolic disorders, renal pathology, or simply benign iatrogenic causes.  \nPerhaps the most recognizable case of these abnormalities is red-colored urine. For example, hematuria is a clinically significant cause of abnormal urine color and may be microscopically present in 1% to 18% of the population. Potential etiologies for hematuria can range from benign conditions, such as exercise-induced hematuria, to more significant diseases, such as renal cell carcinoma and glomerulonephritis [2] . Similarly, myoglobinuria and hemoglobinuria, both of which result in dark red to brown urine, can indicate physiologic abnormalities such as rhabdomyolysis or intravascular hemolysis, respectively [3] . Pharmacological causes of red urine include warfarin, hydroxocobalamin, and metronidazole. Additionally, certain diets such as ones high in carrots, blackberries, rhubarb, or beets can cause red or pink urine [1] . Lastly, congenital diseases such as porphyria, which can affect up to one in 20,000 individuals, can lead to port-wine-colored urine [4,5] .  \nIn contrast, brown, yellow, and orange urine colors have a narrower differential diagnosis. Dehydration can be a common cause of yellow or orange urine color [6] . Bilirubin can also skew the urine toward a brownorange hue; therefore, diseases that lead to its accumulation can affect urine color [7] . Malignancies of melanocytes, such as melanomas, can cause melanin leakage into the urine, also producing a brown color [6] . Additionally, orange urine can be caused by medications such as phenazopyridine, isoniazid, riboflavin, and sulfasalazine, and brown urine has been associated with medications such as acetaminophen and nitrofurantoin [1] .  \nWhite or cloudy urine has also been noted in some patients. High amounts of calcium or phosphate can ca","cbCail96MUKbtPns","https://ap.wps.com/l/cbCail96MUKbtPns","pdf",2044706,7,"English","# Introduction\n## Normal urine coloration and pigment mechanisms\n## Differential diagnosis by urine color (red, brown/yellow/orange)\n## Differential diagnosis by urine appearance (white/cloudy)\n## Blue or green urine: etiologies and clinical clues\n## Diagnostic approach and supportive tools\n## How to cite","[{\"question\":\"Why can abnormal urine colors be difficult to interpret clinically?\",\"answer\":\"Urine color changes can reflect systemic disease, metabolic or renal pathology, or benign iatrogenic causes, and patients may present with incidental findings that require careful context.\"},{\"question\":\"What causes blue-green urine according to the case report’s differential?\",\"answer\":\"The report describes iatrogenic, endogenous, and infectious causes, including drug effects (e.g., methylene blue) and organisms such as Pseudomonas aeruginosa, as well as metabolic conditions like alkaptonuria and Hartnup disease.\"},{\"question\":\"What diagnostic tools are mentioned to narrow the cause of abnormal urine color?\",\"answer\":\"The report references dipstick urinalysis for semiquantitative clues (e.g., hematuria or bilirubinuria) and spectrophotometry for suspected metabolic disorders involving porphyrins or homogentisic acid.\"}]","Diagnostic Approach to Abnormal Urine Colors - Lessons From a Case of Blue-Green Urine | PDF",1791846851]