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

Khan, Fahad; Chaudhry, Muhammad; Qureshi, Noorulain; Cowley, Benjamin D.

doi:10.4061/2011/419213

Cited by 83 publications

(126 citation statements)

References 9 publications

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“…The presence of these bacteria in the intestinal tract favours the metabolism of indole sulfate, resulting in the formation of indirubin (red) and indigo (blue). These metabolites then concentrate in the plastic tubing and the catheter producing an intense purple colour [6], giving rise to the purple urine bag syndrome [Table/ Fig-3]. The urine culture report of our patient was positive for Providencia which was sensitive to Ceftriaxone.…”

Section: Discussionmentioning

confidence: 97%

Purple Urine Bag Syndrome

et al. 2015

JCDR

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A 36-year-old male was brought to the hospital for change of his urinary catheter. He had a history of fall from a tree four months back following which he developed weakness of both his lower limbs associated with urinary incontinence. He was under treatment for traumatic paraparesis elsewhere and bladder was catheterized with plastic urinary bag since then. The colour of the urine at the time of catheterization was normal and clear.On probing the history further, the patient also revealed that he had noticed that the colour of urine had changed from straw colour to purple colour for the past six days. He also gave a history of constipation for the past few weeks. There was no history of associated fever, abdominal pain, vomiting or loss of weight. He was not a known diabetic or hypertensive. He also had no history of previous urinary problems or surgeries.On examination, he was comfortable and haemodynamically stable.Cardiovascular, respiratory and abdomen examination were normal. Neurological examination revealed weakness of both lower limbs. Basic investigations were done which revealed a mild leucocytosis (13000/mm 3 ) and evidence of a urinary tract infection. The findings are tabulated in [Table/ Fig-1].The urine in the bag was strikingly purple in colour [Table/ Fig-2]. Urine examination showed 14 to 16 pus cells/HPF with no RBC's. Urine analysis for glucose and albumin was negative. Urine culture revealed the presence of Providencia which was sensitive to Ceftriaxone, Ofloxacin, Amikacin, and Co-Amoxyclav. He was started on parenteral Ceftriaxone 1 gm twice a day for a period of five days and urinary catheter was also changed. After treatment with antibiotics as well as change of the urinary catheter, the purple urine returned to its normal colour.Keywords: Indigo, Indirubin, Pink purple urine, Providencia, Tryptophan Internal Medicine SectionPurple Urine Bag Syndrome Purple urine bag syndrome (PUBS) is a rare disorder seen in elderly persons, wherein the urinary bag and the tubing turn in to purple colour. It is usually seen in patients who are on urinary catheters for a long time. Purple coloured urine occurs due to the accumulation of indigo and indirubin, which are the end products of tryptophan metabolism due to the action of sulfatases and phosphatases formed by bacteria like Providencia, Citrobacter, Enterobacter, Klebsiella etc. We present this interesting phenomenon of purple urine in a young male who was on prolonged urinary catheterization. The urine culture was positive for Providencia and constipation was an added risk factor for the purple urine. The urinary catheter and tubing was changed along with a course of antibiotics which lead to the normalization of the urine colour.

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Section: Discussionmentioning

confidence: 97%

Purple Urine Bag Syndrome

et al. 2015

JCDR

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“…On the other hand, some patients may have symptoms of a UTI, and will require more of a diagnostic work-up and management, including routine antibiotics, followed by a urine culture and antibiotic susceptibility testing, leading to an antibiotic regimen tailored to the causative bacteria. 1 This case presentation clearly follows the aforementioned approach to PUBS in a patient with a symptomatic UTI. While major sequelae are very infrequent, there have been reports of the development of Fournier's gangrene, a perineal infection with a high mortality rate, requiring debridement of the necrotic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…The bacteria most commonly associated with this condition include: Providencia stuartii, Providencia rettgeri, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Morganella morganii, and Enterococcus spp. 1 A seemingly paradoxical aspect of this condition is that although many individual risk factors occur frequently, PUBS itself presents rarely. This is likely due to the fact that numerous risk factors must be present concurrently, and if any key risk factor is not present, an appreciable amount of purple urine discoloration will not be produced.…”

Section: Discussionmentioning

confidence: 99%

“…This results in the production of indigo, appearing blue, and indirubin, appearing red, which combine to give a purple appearance. 1 This purple color is often alarming and distressing to both the physician and patient, but is generally considered a benign process, simply requiring the appropriate antibiotics to treat the UTI as well as changing of the urinary catheter and drainage bag for treatment.…”

Section: Introductionmentioning

confidence: 99%

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Purple Urine Bag Syndrome: An Educational Case of a Colorful Condition in the Chronically Catheterized

Gebrmichael¹,

Feleke²,

Ahmed³

et al. 2017

mjm

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“…1 Bacteria containing sulphatase and phosphatase enzymes result in transformation of indoxyl sulphate (a metabolite of tryptophan) to indirubin (red) and indigo (blue) pigments, the mixture of which turns the urine purple.…”

Section: Discussionmentioning

confidence: 99%

Purple urine bag syndrome- changing hue!

et al. 2013

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An 85 year old woman was admitted in our care with a diagnosis of systemic hypertension and cerebrovascular attack (ischemic) with right sided hemiplegia. On reviewing the history, the relatives gave a history of anorexia, constipation and cold intolerance for 6 months. There was a history of inadequate oral intake following the untimely death of her daughter a few weeks prior to her admission in this hospital. On admission, there was an indwelling urinary catheter and nasogastric tube in situ.Patient was drowsy, responding to commands intermittently, afebrile with a heart rate of 54/minute and a blood pressure of 140/90 mmHg. General examination was unremarkable except for dry tongue, coarse skin, pallor and puffiness of face. Neurological examination showed signs of right sided hemiparesis with bilateral extensor plantars. Other system examination was unremarkable.Complete blood count revealed an Hb of 9.4 mg/dl with neutrophilic leukocytosis. ESR was 60 mm at the end of first hour. Basal metabolic profile was within normal limits while serum sodium was 109 mEq/L. 2D Echo was normal except for grade 1 diastolic dysfunction. MRI brain revealed diffuse brain atrophy and periventricular leucomalacia. Thyroid profile revealed low serum T3 (0.43 ng/ml; ref. range 0.6-1.81), T4 (0.51ng/dl; ref. range 3.2-12.6) and a high serum TSH (60 IU/ml). Hyponatremia correction was done and thyroid hormone replacement was initiated. Within a few days of care, her general medical condition and neurological condition improved remarkably but indwelling urinary catheter ABSTRACTPurple Urine Bag Syndrome (PUBS) is a unique disease entity characterised by purple discoloration of urine secondary to recurrent urinary tract infections with indigo and indirubin producing bacteria and is predominantly seen in constipated, chronically debilitated and catheterised women with alkaline urine. This syndrome indicates underlying recurrent urinary tract infections (UTIs) associated with higher incidence of mortality and morbidity than urinary tract infection alone without this occurrence. This article is about an elderly hypothyroid woman with PUBS and reviews the need to be aware of this entity.

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

Cited by 83 publications

References 9 publications

Purple Urine Bag Syndrome

Purple Urine Bag Syndrome

Purple Urine Bag Syndrome: An Educational Case of a Colorful Condition in the Chronically Catheterized

Purple urine bag syndrome- changing hue!

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