Cytomegalovirus ureteritis - An unreported cause of hematuria in an immunocompetent individual

A middle-aged woman presented with painless hematuria and passage of large clots. Two weeks earlier, she had pyrexia with upper respiratory tract symptoms. Imaging studies revealed no lesions of the urinary tract. Cystoscopy showed clots and oozing of blood from the left ureteric orifice. Urine cytology and mucosal biopsies were normal. Left nephroureterectomy was done as an emergency procedure; the hematuria stopped following the procedure. Histopathology revealed cytomegalovirus inclusion bodies in the mucosa of the excised ureter. This unusual presentation of hematuria has not been reported previously.