Purple urine bag syndrome with acidic urine

Purple urine bag syndrome (PUBS) is a unique disease entity characterized by an alarming purple discoloration of the urine secondary to recurrent urinary tract infections with indigo- and indirubin-producing bacteria. It is usually associated with prolonged urinary catheterization and chronic debilitated states. We hereby present a concise review of this rare phenomenon with historic perspectives, epidemiology, emphasizing on current concepts of etiology, pathogenesis, relevant clinical associations, treatment modalities, prognosis, and future directions in PUBS. In addition, we highlight an interesting occurrence of this intriguing phenomenon in a 39-year-old gentleman at our institution.

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“…In 2008, Chung reported a case of PUBS with acidic urine [6] which casts doubt on the association of urine alkalinity.…”

Section: Pathogenesismentioning

confidence: 99%

Purple Urine Bag Syndrome: An Alarming Hue? A Brief Review of the Literature

Khan

Chaudhry

Qureshi

et al. 2011

International Journal of Nephrology

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“…Constipation prolongs the transit time of tryptophan, leading to higher urinary indoxyl sulfate levels 8. The provocative organisms show increased growth in alkaline urine,9 although cases of PUBS in acidic urine have also been reported 10. Interestingly, despite PUBS being reported mostly in patients with long-term urinary catheters,11 our patient developed the condition only 1 week after insertion.…”

Section: Discussionmentioning

confidence: 56%

Single case of purple urine bag syndrome in an elderly woman with stroke

Richardson-May

2016

BMJ Case Reports

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Purple urine bag syndrome is an unusual condition that heralds an underlying urinary tract infection, in which certain bacteria produce a purple discolouration within the catheter bag of affected cases. It is most often seen in elderly women with constipation. While alarming, it can be resolved by treating the infection causing it. This report presents an elderly patient who developed the condition while an inpatient, and discusses the pathogenesis behind the condition.

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“…Most PUBS cases occur in alkaline urine, pH [ 7; however, PUBS in acidic pH has been reported [4,11]. The common bacterial strains associated with PUBS include: E. coli, Proteus species, Pseudomonas species, Enterococcus species, Citrobacter species, Klebsiella species, Morganella and Providencia species [2,6].…”

Section: Discussionmentioning

confidence: 99%

Recurrent purple urine bag syndrome presenting with full spectrum of disease severity: case report and review of literature

et al. 2016

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Purple urine bag syndrome (PUBS) is a unique phenomenon characterized by purple discoloration of the urinary catheter bag and tubing following urinary catheterization lasting for hours to days. The purple discoloration is a mixture of indirubin dissolved in plastic with indigo on its surface. PUBS is most commonly associated with urinary tract infection (UTI) caused by bacteria with indoxyl phosphatase/sulfatase activity. It occurs predominantly in chronically catheterized, constipated elderly female patients. It usually appears to be asymptomatic and harmless, but rarely it can present as a severe illness. We report on a 29-year-old female with urinary ileal diversion presenting with multiple episodes of PUBS each with an asymptomatic state of varying severity, symptomatic UTI and severe sepsis requiring intensive care. To our knowledge, this is the first report where a single young patient had recurrent PUBS which presented with a full spectrum of disease severity at different occasions.

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Purple urine bag syndrome with acidic urine

Cited by 38 publications

References 13 publications

Purple Urine Bag Syndrome: An Alarming Hue? A Brief Review of the Literature

Purple Urine Bag Syndrome: An Alarming Hue? A Brief Review of the Literature

Single case of purple urine bag syndrome in an elderly woman with stroke

Recurrent purple urine bag syndrome presenting with full spectrum of disease severity: case report and review of literature

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