Unilateral Purple Urine Bag Syndrome in an Elderly Man with Nephrostomy

Abstract

Purple urine bag syndrome, or PUBS, is a manifestation of a complicated urinary tract infection. Organisms such as Escherichia coli (E. coli) and Enterococcus can reside in urinary catheters and exhibit the purple color detected in this phenomenon. Risk factors described for this syndrome include the use of plastic urinary catheterization, the malfunctioning of the catheter, and long-term institutionalization. This disorder could be the earliest presentation of a urinary catheter flaw and requires immediate intervention and revision. In our case, a male resident of nursing home presented with urosepsis and appropriate antibiotics were initiated. Computed tomography (CT) urogram was done and showed left kidney hydronephrosis and bilateral staghorn calculi. To address the source of infection, a nephroureteral drain was placed in both kidneys. A few days after the initiation of treatment and urological intervention, urine on the left side became purple. The urologist re-evaluated the nephroureteral drainage tubes and replaced them. The purple color in the urine resolved later. In our case, PUBS was the earliest sign of urinary drainage malfunctioning and required early intervention and treatment.

Purple Urine Bag Syndrome: A Rare and Surprising Clinical Presentation

“…The prevention of catheter-associated UTIs includes shortening the duration of catheterization when possible. Also, eliminating blockages in urinary catheters reduces the risk of infection when urine is allowed to flow through the catheter tubing as designed [ 9 ]. Avoiding chronic indwelling catheters and employing periodic catheter exchanges are two of the most common recommendations to avoid UTIs and PUBS.…”

A case of purple urine bag syndrome in an elderly patient

“…5,6 The interaction between the plastic of the CV tube and the catheter collection bag and the indigo and indirubin pigments, as well as the high bacterial load, are fundamental criteria for the purple urine phenomenon to occur. [7][8][9] Dehydration is considered a risk factor for the onset of PUBS due to the increased concentration of indigo and indirubin in urine; the presence of alkaline urine is a contributing but not necessary factor, since several cases of PUBS have been described in the context of acid urine. Moreover, in patients with chronic constipation, the conversion of tryptophan to indole increases because the prolonged intestinal transit time determines an alteration of the bacterial flora.…”

An elderly man with purple urine

“…[3][4][5] In addition, PUBS has also been reported as the first sign of Fournier's gangrene in immunocompromised patients and as an early indicator of multidrug resistant vulvar abscess and urinary drainage malfunction. 2,6,7 Hence, when encountering any patient with PUBS, a thorough clinical history and physical examination is encouraged to ensure correct management.…”