Purple urine bag syndrome: a truly harmless sign?

Abstract

Purple urine bag syndrome is an uncommon condition that describes the purple discolouration of a catheter bag and tubing. It mainly affects patients with limited mobility who have long-term catheters. Although benign in nature per se, its presence can alarm both patient and practitioner unfamiliar with the syndrome. Here, we describe two cases of asymptomatic patients who both presented to outpatient clinic with the characteristic purple discolouration of their long-term catheters and tubing. The report discusses the pathophysiology of the syndrome and initial investigation and management. Although the syndrome is considered benign, it may signify occult urine tract infection. This should not be ignored even if the patient is asymptomatic, given the likely co-morbidities of the patients affected. Healthcare professionals - particularly urologists and geriatricians - need to be aware of this unusual syndrome so as to initiate appropriate investigation and possible treatment as soon as possible.

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

“…It's usually considered a benign entity and normally disappears once infection has resolved [7]. However, there are few reports of associations with severe cases, probably owning to severity of infection rather than to the color change itself [6,8]. In the case we described, aggressive treatment was needed due to coexisting bacteremia and UTI with hemodynamic instability.…”

“…PUBS can be worrisome for individuals unfamiliar with this finding [1,6]. It's usually considered a benign entity and normally disappears once infection has resolved [7].…”

Une couleur inhabituelle

“…La connaissance de ce syndrome est importante, pour rechercher une infection urinaire sous-jacente, souvent nosocomiale à bactérie multi-résistante, et les facteurs de risque tels que la déshydratation et la constipation [5]. Le risque d'évolution vers un sepsis sévère n'est.…”

“…Le risque d'évolution vers un sepsis sévère n'est. pas nul chez ces patients fragiles [5]. Sur le plan thérapeutique, une antibiothérapie et un changement de sonde urinaire sont préconisés en cas d'infection urinaire associée aux soins (IUAS, recommandations SPILF 2015).…”

An elderly man with purple urine

“…Bacterial sulphatases and phosphatases then act on indoxyl sulphate, producing indoxyl, which is oxidised into indirubin and indigo. 1,2…”