Purple urine bag syndrome:A simple and rare spot diagnosis in Uroscopic rainbow

Abstract

Purple urine bag syndrome (PUBS) is benign pathology but an alarming symptom to the patients and his/her relatives because of purple discoloration of urine in collecting bag and tubing. Colour of the urine is purple because of tryptophan metabolite named Indigo and Indirubin. In urinary tract infection, sulphatase and phosphatase producing bacteria involved in pathogenesis of PUBS. Here, we discuss a case of 60 year male patient with spinal cord injury with neurogenic bladder presented in surgical emergency with purple colour urine in urobag.

Purple Urine Bag Syndrome in a Home-Dwelling Elderly Female with Lumbar Compression Fracture: A Case Report

“…In those patients, hospitalization, the onset of decubitus, and the use of indwelling catheter are highly probable. Proteus detection in urine is one of the predictive factors for urologic complications in persons with SCI [ 27 , 30 ]. Results from our laboratory for the previous period (2020–2023) show an average incidence of P. mirabilis presence in urine samples of 1.91% for both hospitalized patients and outpatients in the region of Vojvodina, Serbia ( Table 1 ).…”

Purple pleural fluid secondary toAcinetobacter baumanniiinfection

“…Purple discolouration of the pleural fluid is a rare phenomenon that occurs most likely due to the breakdown of tryptophan metabolites into indoxyl by bacterial phosphatases and sulfatases, which break down into indigo (blue) and indirubin (red), a pathophysiology analogous to the purple urine bag syndrome 1. Such discolouration of pleural fluid should prompt the physician to consider the possibility of bacterial infection and initiate treatment accordingly while awaiting confirmation.…”

What is happening in that urinary catheter bag?

“…PUBS is a bright purple discoloration of the lining and tubing of urinary catheter bag occurring in patients, especially those in the bedridden state, on long-term urinary catheterization, caused by Urinary Tract Infections (UTI) by bacteria producing sulfatase or phosphatase. [1][2][3] PUBS was described in 1812 when physicians taking care of King George III noted bluish discoloration in his urine. 4 In the literature the first case is reported in 1978.…”

“…5 Constipation and use of laxatives are frequently reported among patients with PUBS, supporting the fact that a decrease in intestinal motility causes bacterial overgrowth in the intestine increasing the metabolism of tryptophan to indole and resulting in high levels of indigo (blue) and indirubin (red) pigments in the urine, responsible for the purple colour of urine. [1][2][3]6 The most common bacteria associated with PUBS are gram-negative, including E. coli, Enterococcus species, Proteus mirabilis, Morganella, and Klebsiella pneumoniae. 7 The interaction between the bag (i.e., the plastic) and pigments as well as a high bacterial load is important in precipitating PUBS.…”