Differential Diagnosis for Green Urine

• Single most likely diagnosis
  • Medication effect (e.g., methylene blue, indomethacin, or propofol): Certain medications are known to cause a change in urine color, including turning it green, due to their chemical properties or metabolites.
• Other Likely diagnoses
  • Urinary tract infection (UTI) with certain bacteria (e.g., Pseudomonas aeruginosa): Some bacteria can produce pigments that alter urine color.
  • Food or dye ingestion: Consuming foods or substances with strong pigments (like asparagus or certain dyes) can temporarily change urine color.
• Do Not Miss diagnoses
  • Biliverdinuria: Although rare, this condition involves the excretion of biliverdin, a green pigment, in the urine, which could be indicative of a severe underlying condition affecting heme metabolism.
  • Leptospirosis: This bacterial infection can cause a range of symptoms, including changes in urine color, and is critical to diagnose due to its potential severity and the need for prompt treatment.
• Rare diagnoses
  • Porphyrias: A group of disorders that can lead to the accumulation of porphyrins, which may cause urine to turn various colors, including green, due to the specific type of porphyrin and its metabolites.
  • Melanogenuria: A condition where melanin or its metabolites are excreted in the urine, potentially altering its color, though this is exceedingly rare and usually associated with other significant symptoms.