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

Abstract

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.

Purple Urine Bag Syndrome in a Critically Ill Patient: Case Report

“…Our patient had important predisposing factors such as indwelling urinary catheterization, UTI, female gender, high alkaline urine, and relevant comorbidities including renal failure which has specifically been reported as a risk factor because of impaired clearance of indoxyl sulfate [3]. It is important to note that this event occurred relatively quickly after the procedure (3 h), as most cases are reported to take place many hours or days later [4].…”

Purple urine bag syndrome in an 80-year-old female cameroonian

“…Even though alkaline urine has been reported by a majority of authors to be a risk factor for the development of PUBS, 1 2 6 7 8 it has also been described in patients with acidic urine. 9 10 …”

“… 2 5 Indican is then oxidized by sulfatase/phosphatase-containing bacteria colonizing the urinary catheter system to the pigment indigo (blue) and indirubin (red) [ Figure 2 ]. 8 Oxidation of indican is facilitated by an alkaline urine. When these pigments get in contact with a plastic urine bag or tubing, it produces a purple discoloration of the urine bag.…”

“…Although most of the reported cases of PUBS are benign, 5 6 11 some reports have associated PUBS to severe complications such as severe sepsis requiring aggressive treatment in the intensive care unit 8 and Fournier's gangrene in an immunocompromised patient. 12 Since urine discoloration is not a sign of UTI, PUBS is therefore classified as asymptomatic bacteriuria.…”

Purple Urine Bag Syndrome in Geriatric Hospital: A Report of 2 Cases

“…These pigments mix and react with the urine bag and tubing and produce a purple-colored urine. 1,5,[11][12][13] Several bacteria are often associated with PUBS. These bacteria are mainly gram negative and include Providencia rettgeri, Providencia stuartii, Proteus mirabilis, Klebsiella pneumonia, Enterococcus species, Escherichia coli, Morganella morganii, Pseudomonas aeruginosa, Citrobacter species, and group B streptococci.…”