Working in the ER, I’ve encountered all sorts of people.  I entered the room of a middle-aged man and proceeded to interview the patient after introducing myself.  When I asked him what had brought him to the ER that day, he advised, “I have smoke coming from my penis.”

I had to work extremely hard to hide my amusement and carried on with my interview and exam. His exam was completely unremarkable, but I went ahead and ordered a urinalysis and blood work. Quite surprisingly, his urinalysis was horrific and his lab work not much better.

We proceeded with a computed tomography scan of his abdomen to assess his kidneys better. We found that his kidneys were filled with gas from a gas-producing pyelonephritis. Literally every time this patient voided he was expelling gas from the kidneys, which he interpreted as looking like smoke. I will certainly never forget my patient with the “smoking penis.”

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