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. (Hong Kong j.emerg.med. 2009;16:159-160) Keywords: Indwelling catheters, purple urine bag syndrome, urinary catheterization, urinary tract infections CaseAn 81-year-old gentleman presented to our Accident and Emergency Department in October 2008 with a complaint of discoloured urine for one day. He had history of hypertension, ischaemic heart disease and stroke requiring long-term urinary catheterization. He had no fever, urinary tract symptoms nor a history of recent trauma. There was no blood clot noted in the drained urine and he was asymptomatic except for the discoloured urine. His blood pressure was 179/78 mmHg and his pulse rate was 58 beats per minute. He was afebrile and not in respiratory distress. The most striking feature was that the drained urine was purple in colour and the urine bag seemed stained purple too (Figure 1). No blood clot was seen inside the tubing or the urinary bag. He had only been put on his usual medications (lisinopril, methyldopa and simvastatin) for stroke and hypertension. He had not taken other medications or Chinese herbal medicine lately. A urine culture was saved and he was treated as urinary tract infection. The urinary catheter and drainage bag were changed and he was given a course of cefuroxime sodium (Zinnat). The urine culture showed greater than 10 5 colony-forming units per millilitre of Proteus mirabilis. The urine discolouration resolved soon after treatment of the urinary tract infection and he recovered well.

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Following the first triple-drug MDA for lymphatic filariasis in Samoa in 2018, unexpected persistence of Mf-positivity in 18 (15%) of 121 antigen-positive persons was observed in a nationwide household survey 1-2 months later, raising concerns about MDA efficacy. In 2019, a monitored treatment study was done before and 7 days after directly observed weight-based treatment. Mf presence and density were evaluated using 1 mL membrane filtered venous blood, and 60uL thick blood films on slides prepared from venous or fingerprick blood. All 14 participants were still Mf positive on filters from venous blood pre-treatment samples, but two were negative by slide made from the same samples. Mf were cleared completely by day 7 in 12 of 13 participants followed up, and by day 30 in the remaining participant. Filtered blood using EDTA samples (to reduce clumping of Mf) is preferred over slides alone for improving the likelihood of detecting Mf and estimating their density. The triple-drug MDA strategy was effective at clearing Mf by day 30 when given and taken at the correct dose.