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To the Editor.—
"When the Urine is Red" (237:2753, 1977) is an extremely interesting and useful brief. It does, however, omit one class of "red urine" that I have observed.To simulate hematuria, some psychopathic or malingering patients have added not blood but other red substances to urine. Several whom I have observed have added ketchup or tomato juice, and this gave the urine a typical tomato odor. Isolation and identification of the red pigment of the tomato (lycopene, also found in watermelons) confirmed that ketchup or tomato juice had been added.
Boutwell JH. More Causes of Red Urine. JAMA. 1977;238(14):1501. doi:10.1001/jama.1977.03280150071023
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