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.