What causes blood in my urine and coughing up blood?

Patient

Q: My temperature was 104.5 but has gone down to 99.5 in the last 24 hours. I went to the emergency room yesterday because of high fever for prolonged time, felling miserable and unable to get out of bed yesterday. The hospital put me on ice, started an IV then ran tests for menengitis, strep, and influenza A and B. All came back negative except the spinal tap for menengitis we don't know the results yet. Any idea what I have?

Symptoms:  High temp of 104.5 now at 99.5. Coughing up blood and urinating blood. Body aches, fever, and nausea.
Doctor

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.
With a history of sudden onset hematuria and high-grade fever, further detailed evaluation is required.
Meningitis can be ruled out by clinical examination, as the patients will develop two positive signs known as Kernig's and Brudzinski. I believe your ER doctor must have checked for these signs and then sent for blood work.
Meningitis does not commonly present with blood in urine and has other predominant symptoms like projectile vomiting and severe nausea. However, this still needs to be ruled out.

You need to get a detailed evaluation done with a complete blood count ( CBC ), Urine Routine and Urine culture, CT KUB, ESR, CRP, LFT, and RFT. These tests are necessary to come to a diagnosis. Very high-grade fever can itself cause a little blood in coughing. But hematuria occurs in cases of severe UTI or kidney infections. This can be ruled out by RFT and urine examination.

It is a good sign that the fever has almost come down. This also goes against the diagnosis of meningitis, where the fever is persistent.

Kindly get the tests done as mentioned and you can follow-up with your reports.

Hope this was helpful,
Regards.

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