Purple Urine Bag Syndrome: An Unusual Presentation of Urinary Tract Infection

Abstract

Purple urine bag syndrome (PUBS) is a very rare phenomenon strongly associated with long-term indwelling catheterization that results in an increased risk of urinary tract infection. The color change in the urine bag results from the altered metabolism of tryptophan into color pigments by certain bacteria which produce sulfates and phosphates enzymes. Although it is benign in nature, PUBS results in greater anxiety among patients and their families. The most important risk factors include long-term catheterization, female gender, chronic constipation, old age and bed-bound patients. Here, we present a case of PUBS in a middleaged woman with a history of the neurogenic bladder that needed long-term catheterization along with chronic constipation.

Purple Urine Bag Syndrome: A Rare and Surprising Clinical Presentation

“…The purple coloration is the result of a mixture of indirubin, which provides a red color, and indigo, which provides a blue color. As these two substances mix in the urine, the result is a purple hue [ 2 ]. Both indirubin and indigo are produced by tryptophan metabolism in the gastrointestinal tract as exhibited by the flowchart in Figure 2 .…”

“…It is the result of bacteriuria, whether asymptomatic or causing urinary tract infection (UTI) symptoms, which causes discoloration of the urine seen in a Foley bag. The pathophysiology involves an ongoing bacterial infection in which specific enzymes cause blue- and red-pigmented breakdown products that combine to form grossly purple urine [ 2 ]. Here, we present a rare case of PUBS in an elderly patient with a history of long-term catheterization and constipation.…”

Purple Urine Bag Syndrome: A Peculiar Presentation of a Urinary Tract Infection

“…Treatment involves starting antibiotic therapy, in cases where infection is assumed, and replacing the Foley catheter with a new bag. Furthermore, it is necessary to intervene in the various predisposing factors, namely constipation, good urological hygiene, avoiding chronic indwelling catheters, and employing periodic catheter exchanges [ 1 , 11 , 12 ].…”

Purple urine bag syndrome: A case report

“…A similar case with neurogenic bladder and chronic constipation who also experienced nausea, fever, and a purple urine bag was treated with cefixime at The Kidney Center Karachi [10] . In the era of patient-centered medicine, it is no longer sufficient to treat catheter-associated urinary tract infections (CAUTIs) as a minor issue.…”