Purple urine bag syndrome: A scary but easily manageable condition in a patient with prolonged indwelling urinary catheter

Purple discolouration of urine is not commonly encountered in accident and emergency departments. We report a case of an elderly gentleman on long-term urinary catheter who presented with purple discolouration of urine. He was found to have urinary tract infection caused by the bacteria Proteus mirabilis. The urine became clear after urinary catheter change and antibiotic treatment. This is called the purple urine bag syndrome and emergency physicians should be aware of this uncommon condition and the associated potentially dangerous conditions in order to initiate appropriate management.

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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.

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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.

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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.

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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.

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