Purple Urine Bag Syndrome: A Rare and Surprising Clinical Presentation

DeRon, Nathan; Legan, Carley

doi:10.7759/cureus.33354

Cited by 4 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The medical treatment of PUBS depends on identifying the underlying cause -in most cases a UTI and/or constipation. Catheter replacement, correction of constipation, and antimicrobial therapy directed at the responsible agent are usually sufficient to resolve symptoms [8].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Purple Urine Bag Syndrome: A Rare Phenomenon Managed in Primary Care

Pereira,

Camarinha,

Ferreira

et al. 2024

Cureus

View full text Add to dashboard Cite

Purple urine bag syndrome (PUBS) is a rare manifestation of urinary tract infection (UTI) characterized by bluish-purple discoloration of urine, typically seen in patients with long-term urinary catheters. It occurs due to the bacterial metabolism of dietary tryptophan into indole, which is converted into indoxyl sulfate in the liver and then excreted in the urine, where it reacts with catheter materials under alkaline conditions. Risk factors include chronic constipation, advanced age, female gender, dehydration, and recurrent UTIs. Morganella morganii is one of the bacteria commonly implicated. Although usually benign, PUBS can signal underlying UTIs, especially in asymptomatic patients.The case presented involves an 81-year-old woman with a history of urothelial carcinoma and a monoJ catheter since pelvic exenteration and ureterostomy. She presented with blue-colored urine in the collection bag; she was asymptomatic, but the urinalysis had leukocytes, nitrites and alkaline pH, and the uroculture was positive for M. morganii. Antibiotic therapy resolved the symptoms initially, but recurrence prompted further treatment and optimization of constipation management. PUBS, although rare, poses risks, especially in vulnerable populations. Identification of risk factors and causative agents is crucial for effective treatment, typically involving catheter replacement, antimicrobial therapy, and constipation correction. Prevention focuses on minimizing catheter use, regular replacement, and hygiene optimization. Early recognition and management in primary care settings can prevent complications and reduce patient and caregiver distress.In conclusion, PUBS is a visually evident condition that may serve as an early indication of UTI, particularly in patients with chronic catheterization. Treatment and prevention strategies should be tailored to individual risk factors to prevent the recurrence or persistence of the syndrome. Awareness among healthcare professionals and patients is essential for timely diagnosis and management. The presented case demonstrates the importance of primary care in managing complex conditions and highlights the close patient-physician relationship in such settings.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Prevention relies on the minimal possible use of catheters, their regular replacement (when removal is not possible), and optimized device hygiene. Prior correction of risk factors such as constipation also reduces the likelihood of this complication occurring [5,8].…”

Section: Discussionmentioning

confidence: 99%

Purple Urine Bag Syndrome: A Rare Phenomenon Managed in Primary Care

Pereira,

Camarinha,

Ferreira

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Faia,

Martins,

Martins

2023

Cureus

View full text Add to dashboard Cite

Purple urine bag syndrome (PUBS) is a peculiar phenomenon and corresponds to the appearance of purplish-colored urine. It is associated with urinary tract infections occurring mainly in debilitated elderly women with constipation and long-term indwelling urinary catheters. We share a case involving PUBS in an 87-year-old female patient, explore the pathophysiology, and discuss potential management options for this uncommon syndrome.

show abstract

“…Some bacteria have been reported in PUBS, including Proteus species, Escherichia coli, Providencia rettgeri, Providencia stuartii, Klebsiella pneumoniae, Enterococcus species, Pseudomonas aeruginosa, and Morganella morganii. 8,15,16 Our patient is a 76-year-old female with a history of immobilization in the past three years and was on chronic urinary catheterization, which was applied by a non-medic staff with no sterile procedure. She often experienced constipation.…”

Section: Discussionmentioning

confidence: 99%

A Peculiar Manifestation of Urinary Tract Infection in a 76-year-old Female

Alius Cahyadi,

Angelina Yuwono,

Nicholas Adrianto

et al. 2023

IJTID

View full text Add to dashboard Cite

Purple Urine Bag Syndrome (PUBS) is a rare and benign clinical phenomenon associated with urinary tract infections, characterized by the distinctive purple discoloration of a urinary catheter bag. The underlying cause of PUBS is related to bacterial activity involved in the breakdown of tryptophan, mainly in individuals with predisposing factors such as long-term catheterization, constipation, alkaline urine, and being female. We present the case of a 76-year-old female patient with a history of tuberculous spondylitis who developed PUBS during her hospital stay. The patient had been bedridden for three years and had been given a urinary catheter, which was routinely replaced by a non-medical family member and without a proper antiseptic procedure. A urine culture revealed the presence of Proteus mirabilis, and the patient was treated with intravenous antibiotics while also replacing the urinary catheter and bag. After five days of treatment, the urine bag and catheter remained clear, and the patient was discharged. PUBS is a significant indicator of urinary tract infection, necessitating prompt medical intervention to prevent complications. Healthcare professionals should be aware of this syndrome to enable early detection and appropriate management.

show abstract

Purple Urine Bag Syndrome: A Rare and Surprising Clinical Presentation

Cited by 4 publications

References 9 publications

Purple Urine Bag Syndrome: A Rare Phenomenon Managed in Primary Care

Purple Urine Bag Syndrome: A Rare Phenomenon Managed in Primary Care

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

A Peculiar Manifestation of Urinary Tract Infection in a 76-year-old Female

Contact Info

Product

Resources

About