Purple Urine Bag Syndrome in Two Elderly Men with Urinary Tract Infection

Purple urine bag syndrome is a rare condition in which purple discoloration of urine inside its collection bag occurs. We describe two illustrative cases. The first patient is an 81-year-old man who was hospitalized for a newly diagnosed lymphoma with acute obstructive renal failure for which a nephrostomy procedure was performed. During the hospitalization, a sudden purple discoloration of the suprapubic catheter urine was noted, while the nephrostomy urine had a normal color. Urine culture from the suprapubic catheter was positive forPseudomonas aeruginosaandEnterococcus faecalis; urine from the nephrostomy was sterile. The second case is an 80-year-old man who was admitted for heart failure with cardiorenal dilemma and who was started on intermittent hemodialysis. There was a sudden purple discoloration of the urine in the collection bag from his indwelling catheter. He was diagnosed with anE. coliurinary infection and treated with amoxicillin and removal of the indwelling catheter. These two cases illustrate the typical characteristics of purple urine bag syndrome.

Download Full-text

Purple urine bag syndrome: When the urine turns purple – An under diagnosed spot diagnosis

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1170 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Cathrin Kodde ◽

◽

Till Othmer ◽

David Krieger ◽

Silke Polsfuss ◽

...

Keyword(s):

Urinary Tract ◽

Antibiotic Therapy ◽

Urinary Catheter ◽

Rare Condition ◽

Community Acquired Pneumonia ◽

Purple Urine Bag Syndrome ◽

Indigo Blue ◽

Tract Infections ◽

Purple Urine

The Purple Urine Bag Syndrome (PUBS) is a rare condition in which the urine turns purple. It may occur in Urinary Tract Infections (UTIs) when bacteria metabolize dietary tryptophan to indole resulting in indigo (blue) and indirubin (red). This condition is mostly seen in elderly female patients with permanent urinary bladder catheterization. Patients, relatives and health professionals may be concerned about this discolouration, which is usually harmless. Medical management of PUBS involves frequent urinary bag change, antibiotic therapy and most importantly reassurance. We report an 89-years-old long-term catheterized female nursing home resident who was admitted to the emergency room because of a Community Acquired Pneumonia (CAP). After a few days of inpatient treatment her urine bag turned purple. Antibiotic therapy continued and the indwelling urinary catheter was changed resulting in clear urine. Keywords: Purple urine bag syndrome (PUBS); purple discolouration; urinary tract infection (UTI); long-term catheterization.

Download Full-text

Purple urine bag syndrome in an elderly patient from Colombia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.6251 ◽

2015 ◽

Vol 9 (07) ◽

pp. 792-795

Author(s):

Alvaro Mondragón-Cardona ◽

Carlos Eduardo Jiménez-Canizales ◽

Verónica Alzate-Carvajal ◽

Fabricio Bastidas-Rivera ◽

Juan Carlos Sepúlveda-Arias

Keyword(s):

Elderly Patient ◽

Urinary Tract Infection ◽

Nursing Home ◽

Urinary Tract ◽

Urinary Catheter ◽

Intestinal Bacteria ◽

Rare Condition ◽

Alkaline Ph ◽

Purple Urine Bag Syndrome ◽

Purple Urine

A 71-year-old woman in a nursing home, with indwelling urinary catheter, bedridden, presented with a purple urine collector bag. The purple urine bag syndrome is a rare condition associated with the metabolism of tryptophan by overgrowth of intestinal bacteria. The purple color is formed by a combination of indigo and indirubin produced as a result of phosphatase and sulfatase enzymatic activity of bacteria on indoxyl sulfate, under alkaline pH of the urine. We present the second case of this syndrome reported in Colombia detailing the management of this rare syndrome associated with urinary tract infection. Several conditions should be considered in the differential diagnose of diseases that cause discoloration of the urine.

Download Full-text

Case Report: Purple urine bag syndrome in woman with neurogenic bladder

F1000Research ◽

10.12688/f1000research.19393.1 ◽

2019 ◽

Vol 8 ◽

pp. 979

Author(s):

Senohadi Boentoro ◽

Nugroho Budi Utomo

Keyword(s):

Case Report ◽

Chronic Constipation ◽

Elderly Women ◽

Urinary Catheter ◽

The Elderly ◽

Indwelling Catheter ◽

Army Hospital ◽

First Case ◽

Purple Urine Bag Syndrome ◽

Purple Urine

Purple urine bag syndrome (PUBS) is a rare phenomenon in patients that is associated with the use of a long-term/indwelling urinary catheter. The purple color results from indigo and indirubin, accumulated from bacteria-mediated tryptophan conversion. High risk patients include: the elderly; women; immobilized patients; patients with an indwelling catheter, chronic constipation, alkaline urine or poor hygiene; and those with catheter bags and tubes made of certain types of plastic. We reported PUBS in an elderly woman with an indwelling catheter and chronic constipation which, to our knowledge, was the first case in our hospital. The patient underwent urinary catheter change and received intravenous ciprofloxacin, following which the urine returned to a yellow color and the patient was discharged. This case report describes the diagnosis, management and also strategies for the prevention of PUBS in Gatot Soebroto Army Hospital, Indonesia.

Download Full-text

Purple Urine Bag Syndrome May Not Be Benign: A Case Report and Brief Review of the Literature

Case Reports in Infectious Diseases ◽

10.1155/2013/863853 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Mukul Bhattarai ◽

Hamid Bin Mukhtar ◽

Thomas Walter Davis ◽

Alok Silodia ◽

Hitekshya Nepal

Keyword(s):

Rare Condition ◽

Altered Mental Status ◽

Nephrostomy Tube ◽

Benign Condition ◽

Tertiary Center ◽

History Of ◽

Purple Urine Bag Syndrome ◽

Vancomycin Resistant ◽

Purple Urine ◽

Case Basis

Purple urine bag syndrome (PUBS) is a rare condition in which there is purple discoloration of the urine with its collecting bag and associated tubing occurs. It is considered a benign condition. We report an unusual case of PUBS in an 87-year-old female from nursing home who had a history of recurrent UTI. She also had a history of ureteral obstruction requiring left nephrostomy tube. She was brought to emergency department with altered mental status which developed five days after the occurrence of purple discoloration of the urinary bag. Her urine culture grew vancomycin-resistantEnterococci(VRE) andPseudomonas aeruginosa. She died within three days of hospitalization despite intensive care in tertiary center. This case highlights that PUBS may not always be benign and should be approached on a case-by-case basis because it may signal the underlying UTI which might be very difficult to treat. Failure of recognition of this peculiar color early could delay the appropriate intervention leading to fatal complication. This case also represents the rare occurrence of PUBS in the setting of nephrostomy tube.

Download Full-text

A PUBS Case in a Palliative Care Unit Experience

Case Reports in Oncological Medicine ◽

10.1155/2014/169782 ◽

2014 ◽

Vol 2014 ◽

pp. 1-2

Author(s):

M. R. Restuccia ◽

M. Blasi

Keyword(s):

Palliative Care ◽

Urinary Tract Infection ◽

Rare Case ◽

Rare Condition ◽

Urinary Catheterization ◽

Benign Condition ◽

Alkaline Urine ◽

Purple Urine Bag Syndrome ◽

Purple Urine ◽

Acidic Urine

Purple urine bag syndrome (PUBS) is a rare condition in which purple discoloration of the collecting bag and its associated tubing occurs. It is considered a benign condition. PUBS is usually associated with urinary tract infection occurring in elderly bedridden women, with chronic urinary catheterization. This syndrome is usually reported to occur in alkaline urine, but here we describe a rare case of PUBS involving acidic urine.

Download Full-text

Report of Three Cases of Purple Urine Bag Syndrome which Occurred with a Combination of Both E. coli and M. morganii

Kansenshogaku zasshi ◽

10.11150/kansenshogakuzasshi1970.67.487 ◽

1993 ◽

Vol 67 (5) ◽

pp. 487-490 ◽

Cited By ~ 8

Author(s):

Hirosuke MATSUO ◽

Tsunehisa ISHIBASHI ◽

Chotarou ARAKI ◽

Hiroyuki SAKAMAKI ◽

Hiroyuki MAZUME ◽

...

Keyword(s):

E Coli ◽

Purple Urine Bag Syndrome ◽

Purple Urine

Download Full-text

A case of purple urine bag syndrome in an elderly patient

Geriatric Care ◽

10.4081/gc.2020.8934 ◽

2020 ◽

Vol 6 (3) ◽

Author(s):

Rosa Paola Cerra ◽

Alberto Castagna ◽

Carlo Torchia ◽

Raffaele Costa ◽

Luigi Scalise ◽

...

Keyword(s):

Elderly Patient ◽

Antibiotic Treatment ◽

Bacterial Load ◽

High Protein Diet ◽

Rare Condition ◽

The Elderly ◽

Prevention Measures ◽

Purple Urine Bag Syndrome ◽

High Bacterial Load ◽

Purple Urine

Purple urine bag syndrome is a rare condition that occurs predominantly in the elderly, immobilized and bearer of chronic bladder catheter. It is a phenomenon usually associated with urinary tract infection, particularly in the presence of high bacterial load. The presence of alkaline urine, constipation, high-protein diet and dehydration are predisposing factors. In most cases it is an asymptomatic condition. We described the case of an elderly patient admitted to the geriatric Department in which purple urine was found in the urine collection bag. The culture of urine showed the presence of infection with Klebsiella pneumoniae. Targeted antibiotic treatment and proper hydration determined the resolution of the phenomenon and the resolution of the infection. Although it is an alarming phenomenon due to the particularity of the color of the urine, it is a treatable and solvable condition with an adequate specific antibiotic treatment. Prevention measures are equally effective and consist in eliminating the risk factors for this condition.

Download Full-text

Purple urine bag syndrome in palliative care

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001601 ◽

2018 ◽

Vol 9 (2) ◽

pp. 155-157 ◽

Cited By ~ 1

Author(s):

Sanhapan Wattanapisit ◽

Apichai Wattanapisit ◽

Anong Meepuakmak ◽

Pornnipa Rakkapan

Keyword(s):

Risk Factors ◽

Palliative Care ◽

Rare Condition ◽

Modifiable Risk Factors ◽

Oral Antibiotics ◽

Urinary Catheters ◽

Patient Status ◽

Palliative Care Teams ◽

Purple Urine Bag Syndrome ◽

Purple Urine

Purple urine bag syndrome (PUBS) is a rare condition characterised by urine discolouration. The management of PUBS remains controversial. Four females (mean age 84.5±9.7 years) with palliative conditions (two cancer and two non-cancer cases) presenting PUBS were identified. Urine bags were changed in all cases. Urinary catheters were changed in three cases. Oral antibiotics were prescribed in two cases and used in one case. Urine discolouration was resolved in all cases. One patient (without antibiotic treatment) died on day 5 after presentation of PUBS. Three patients (one out of three cases used oral antibiotics) were clinically stable after the management of PUBS. There was no recurrence of PUBS. Caring for patients with PUBS should be based on clinical decisions, patient status and the goals of care. Palliative care teams should focus on the prevention of PUBS by shortening the duration of catheterisation and minimising modifiable risk factors for this condition.

Download Full-text

Purple urine bag syndrome is a rare manifestation of bacteriuria on bladder catheter: case report

African Journal of Urology ◽

10.1186/s12301-021-00191-5 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Othmane Mohib ◽

Thomas Roland ◽

Margot Fontaine ◽

France Laurent ◽

Camelia Rossi

Keyword(s):

Antibiotic Therapy ◽

Rare Complication ◽

Total Duration ◽

Empiric Antibiotic Therapy ◽

Healthcare Team ◽

Urine Ph ◽

Urine Retention ◽

Bladder Catheter ◽

Purple Urine Bag Syndrome ◽

Purple Urine

Abstract Background Purple urine bag syndrome (PUBS) is a complication of bacterial colonisation of bladder catheters in which urine turns purple in the tubing, as well as in the catheter bag. This rare phenomenon can be very worrisome and stressful for the patients and their families, as well as for the healthcare team taking care of them. Recognising this complication is essential in order to avoid misdiagnosis and erroneous treatment. We report a case of PUBS in a 71-year-old female patient. Case presentation A 71-year-old woman with previous medical history of schizophrenia was admitted to the emergency department for anorexia and suspicion of psychotic decompensation. Acute urine retention and rectal faecal impaction were clinically suspected and confirmed by bladder ultrasound and rectal examination, respectively. The patient underwent bladder catheterisation as well as a rectal enema. The day after her admission, our medical team was approached by the nurse in charge of the patient because of purple urine in her catheter bag and tubing. The diagnosis of PUBS was made with the help of the Oxford urine chart. A dipstick urinalysis revealed alkaline urine (pH = 8), and the urine culture was subsequently positive for Proteus mirabilis, which is sensitive to quinolones, beta-lactams and nitrofurantoin. The bladder catheter was changed. The patient received empiric antibiotic therapy with Levofloxacin 500 mg once daily. After obtaining the antibiogram, the targeted antibiotic therapy was adapted with oral Cefuroxime 500 mg three times a day for a total duration of seven days of antibiotic therapy. There was no recurrence of purple urine. Conclusion PUBS is a rare complication of bacteriuria, which induces a purple colouration of the tubing as well as the catheter bag. It is a simple spot diagnosis, as there is no other known cause of purple urine. This is why we believe that the Oxford urine chart represents a very interesting and easily accessible tool to help clinicians to investigate any abnormal urine colour.

Download Full-text