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Neniwal VK, Swain S, Rulaniya SK, Hota D, Agarwal P, Yadav PK. Purple urine bag syndrome: An unusual manifestation of urinary tract infection, our experience at a tertiary care center. Curr Urol 2023; 17:125-129. [PMID: 37691983 PMCID: PMC10489393 DOI: 10.1097/cu9.0000000000000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background Purple urine bag syndrome (PUBS) is an unusual condition in which a purple discoloration of urine and bag occurs in people with urinary catheters. People with purple urine usually do not complain of any symptoms. The purple discoloration of the urine bag is often the only finding, frequently noted by caregivers. Materials and methods This prospective observational study was conducted at our tertiary care institute from June 2018 to May 2020. A total of 46 patients with PUBS were included in this study. The objective of our study was to record the prevalence of each predisposing factor and to correlate the pathological mechanism through which the PUBS is manifested. Results The mean age of PUBS patients was 67.4years and 67.4% were males. Most patients of PUBS (60.9%) had a urethral catheter, while there was percutaneous nephrostomy in 26.1% patients and 13% patients had a percutaneous suprapubic cystostomy catheter. Among the patients, 69.65% were bedridden or in an institutionalized situation, 73.9% were suffering from chronic constipation, 21.7% were associated with dementia, and 47.8% were cerebrovascular accidents with hemiparesis patients. In addition, 93.5% of patients presented with alkaline urine and 3 patients with acidic urine. The most common bacteria isolated in urine culture were E coli and Pseudomonas. Conclusions Urinary catheter associated urinary tract infection and PUBS is most commonly documented in females, but our study showed that it is more common in males. The appearance of a purple bag does not depend on the material and type of the catheter or the catheterization method. In addition, no correlation was found between the microorganisms isolated from the environment and patients' urine.
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Affiliation(s)
- Vishal Kumar Neniwal
- Department of Urology and Renal Transplant, SCB Medical College Cuttack, Odisha, India
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2
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Oliveira Rodríguez M, Moreno Rodríguez M, Díaz Martín JJ, Prieto García B. Purple urine in Berdon syndrome: a rare finding in the clinic laboratory. Ann Clin Biochem 2023; 60:142-145. [PMID: 36645843 DOI: 10.1177/00045632231152565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION 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. It consists of a change in the colour of the urine that turns purple in a very specific context. CASE REPORT We report the case of a paediatric female patient with Berdon Syndrome with symptoms consistent with urinary tract infection and purple urine discolouration. Urine test revealed leukocyturia and bacteriuria. DISCUSSION Several risk factors have been proposed regarding this syndrome. Among them the commonest are female gender, advanced age, kind of diet (increased dietary tryptophan), alkaline urine and diverse situations that leads to urinary retentions which allows bacteria to work on their substrate for a longer time. Although it is a process that is not associated with gravity, recognizing it is important as treatment is simple and can minimize patient and family distress.
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Affiliation(s)
- Myriam Oliveira Rodríguez
- Laboratory of Medicine, Department of Clinical Biochemistry, 16474Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Moreno Rodríguez
- Laboratory of Medicine, Department of Clinical Biochemistry, 16474Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan J Díaz Martín
- Pediatric Gastroenterology and Nutrition Section, 16474Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Belén Prieto García
- Laboratory of Medicine, Department of Clinical Biochemistry, 16474Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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3
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Saraireh M, Gharaibeh S, Araydah M, Al Sharie S, Haddad F, Alrababah A. Violet discoloration of urine: A case report and a literature review. Ann Med Surg (Lond) 2021; 68:102570. [PMID: 34354830 PMCID: PMC8321942 DOI: 10.1016/j.amsu.2021.102570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Purple Urine Bag Syndrome (PUBS) is an uncommon event that can be described as purple discoloration of urine due to a series of chemical reactions induced by Urinary Tract Infections (UTIs). PUBS has been reported in the past but still remains unrecognized by healthcare givers leading to misdiagnosis and inappropriate management. We report our case alongside a literature review of previously published cases. CASE PRESENTATION We present the first case report of Purple Urine Bag Syndrome in Jordan of a catheterized 80-year-old wheel-chaired female with a history of type 2 Diabetes Mellitus (DM), stage 5 Chronic Kidney Disease (CDK), Hypertension, and ischemic stroke. Her condition was initially misdiagnosed for hematuria but later on was correctly diagnosed with PUBS. She was treated with a course of appropriate antibiotic and by changing her urinary catheter and bag. The patient returned for a follow up visit and her problem resolved with the color of her urine in the urine bag returning back to normal. CLINICAL DISCUSSION PUBS is an uncommon event that occurs in association with UTIs. Such cases are mostly seen in elderly catheterized patients with other risk factors. CONCLUSION Purple Urine Bag Syndrome can be managed by changing urinary catheter, and by the administration of appropriate antibiotics. Such event can be easily misdiagnosed thus leading to unnecessary and consuming measures. Creating a better awareness of this condition among physicians and healthcare givers is essential for better patient outcomes.
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Affiliation(s)
| | | | | | | | - Fadi Haddad
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
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4
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Sabanis N, Paschou E, Papanikolaou P, Zagkotsis G. Purple Urine Bag Syndrome: More Than Eyes Can See. Curr Urol 2019; 13:125-132. [PMID: 31933590 PMCID: PMC6944938 DOI: 10.1159/000499281] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Purple urine bag syndrome (PUBS) is an uncommon clinical entity characterized by purple urine discoloration in the setting of urinary tract infections. Pa-thophysiology of PUBS has been correlated to aberrant metabolism of tryptophan. Multiple predisposing factors have been recognized, namely: female gender, advanced age, constipation, institutionalization, long-term catheter-ization, dementia and chronic kidney disease. Herein, we present a comprehensive review of all PUBS cases reported in PubMed, focusing on the predisposing factors and the microorganisms related to PUBS. METHODS We performed a search in PubMed database for articles referring to PUBS, published in English, French, Spanish and German from January 1978 until November 2017. The literature recruitment strategy was based on several keywords and Medical Subject Heading combination such as "purple urine bag syndrome" or PUBS or "urine discoloration". The finally selected articles were categorized into case reports/series (88 articles including 112 patients) and studies (10 articles including 134 patients). Demographical data as well as predisposing factors were recorded and further analyzed. RESULTS According to our findings, mean age of PUBS patients was 78.9 ± 12.3 years, 70.7% were female while 90.1% were suffering from constipation, 76.1% were in a bedridden situation, 45.1% were experiencing long-term catheterization, 42.8% had been diagnosed with dementia, 14.3% had recurrent urinary tract infections and 14.1% were chronic kidney disease patients. 91.3% of patients presenting with PUBS alkaline urine were observed while the most common microbe in urine cultures was E. coli. CONCLUSIONS PUBS is considered benign process in the majority of catheterized patients. Clinicians should be aware of the syndrome that may indicate serious comorbidities.
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Affiliation(s)
| | - Eleni Paschou
- Department of General Practice & Family Medicine, General Hospital of Livadeia, Voiotia, Greece
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5
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Yang HW, Su YJ. Purple Urine Bag Syndrome in the Elderly. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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6
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Kamelamela N, Zalesne M, Morimoto J, Robbat A, Wolfe BE. Indigo- and indirubin-producing strains of Proteus and Psychrobacter are associated with purple rind defect in a surface-ripened cheese. Food Microbiol 2018; 76:543-552. [PMID: 30166186 DOI: 10.1016/j.fm.2018.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/17/2018] [Accepted: 07/19/2018] [Indexed: 01/28/2023]
Abstract
The rinds of surface-ripened cheeses have expected aesthetic properties, including distinct colors, that contribute to overall quality and consumer acceptance. Atypical rind pigments are frequently reported in small-scale cheese production, but the causes of these color defects are largely unknown. We provide a potential microbial explanation for a striking purple rind defect in a surface-ripened cheese. A cheese producer in the United States reported to us several batches of a raw-milk washed-rind cheese with a distinctly purple rind. We isolated a Proteus species from samples with purple rind defect, but not from samples with typical rind pigments, suggesting that this strain of Proteus could be causing the defect. When provided tryptophan, a precursor in the indigo and indirubin biosynthesis pathway, the isolated strain of Proteus secreted purple-red pigments. A Psychrobacter species isolated from both purple and normal rinds also secreted purple-red pigments. Using thin-layer chromatography and liquid chromatography-mass spectrometry, we confirmed that these bacteria produced indigo and indirubin from tryptophan just as closely related bacteria make these compounds in purple urine bag syndrome in medical settings. Experimental cheese communities with or without Proteus and Psychrobacter confirmed that these Proteobacteria cause purple pigmentation of cheese rinds. Reports of purple rinds in two other cheeses from Europe and the observation of pigment production by Proteus and Psychrobacter strains isolated from other cheese rinds suggest that purple rind defect has the potential to be widespread in surface-ripened cheeses.
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Affiliation(s)
- Noelani Kamelamela
- Department of Biology, Tufts University, 200 Boston Ave., Medford, MA, 02155, USA
| | - Michael Zalesne
- Department of Biology, Tufts University, 200 Boston Ave., Medford, MA, 02155, USA
| | - Joshua Morimoto
- Tufts University Sensory and Science Center, Tufts University, 200 Boston Ave., Medford, MA 02155, USA; Department of Chemistry, Tufts University, 62 Talbot Ave., Medford, MA, 02155, USA
| | - Albert Robbat
- Tufts University Sensory and Science Center, Tufts University, 200 Boston Ave., Medford, MA 02155, USA; Department of Chemistry, Tufts University, 62 Talbot Ave., Medford, MA, 02155, USA
| | - Benjamin E Wolfe
- Department of Biology, Tufts University, 200 Boston Ave., Medford, MA, 02155, USA; Tufts University Sensory and Science Center, Tufts University, 200 Boston Ave., Medford, MA 02155, USA.
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7
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Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep 2018. [PMID: 29564123 DOI: 10.3892/br.2018.1046.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980-2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011-2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.
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Affiliation(s)
- Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.,Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
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8
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Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep 2018; 8:249-256. [PMID: 29564123 PMCID: PMC5854937 DOI: 10.3892/br.2018.1046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980-2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011-2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.
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Affiliation(s)
- Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
- Correspondence to: Dr Yu-Jang Su, Department of Emergency Medicine, Mackay Memorial Hospital, 92 Section 2 Chung-Shan North Road, Taipei 10449, Taiwan, E-mail:
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9
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Guei MC, Yao KH, Lagou DA, Coulibaly PNA, Sawadogo A, Moudachirou MIA, Tia WM, Konan SD, Diopoh S, Cherif I, Ackoundou-N'Guessan KC, Gnionsahe DA. [Purple urine-bag syndrome: A case report]. Nephrol Ther 2018; 14:172-174. [PMID: 29415863 DOI: 10.1016/j.nephro.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/07/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
Purple urine-bag syndrome is a rare condition that occurs in patients with indwelling urinary catheters carried over a long period and frequently associated with a urinary tract infection. It is characterized by the appearance of a violet coloration of the probe and/or the urine collection bag. We report the first case in West Africa that occurred in a 47-year-old woman in uremic encephalopathy and carrier of a urinary catheter, which presented a violet color of the tubing and urine-bag associated with a urinary tract infection. The outcome was favorable under antibiotic therapy. Many patients benefit from the installation of urinary catheters for various reasons and the occurrence of this syndrome should lead the medical team to systematically seek an underlying urinary tract infection to avoid if possible paraclinical assessments generally costly to our patients without medical coverage in our developing countries.
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Affiliation(s)
- Monlet Cy Guei
- Service de néphrologie, CHU de Yopougon, BP 632, Abidjan 21, Côte d'Ivoire.
| | - Kouamé Hubert Yao
- Service de néphrologie, CHU de Treichville, Km 1, boulevard de Marseille, BP V 206, Abidjan, Côte d'Ivoire
| | | | | | - Amidou Sawadogo
- Service de néphrologie, CHU de Yopougon, BP 632, Abidjan 21, Côte d'Ivoire
| | | | - Weu Melanie Tia
- Service de néphrologie, CHU de Yopougon, BP 632, Abidjan 21, Côte d'Ivoire
| | - Serge Didier Konan
- Service de néphrologie, CHU de Treichville, Km 1, boulevard de Marseille, BP V 206, Abidjan, Côte d'Ivoire
| | - Sery Diopoh
- Service de néphrologie, CHU de Treichville, Km 1, boulevard de Marseille, BP V 206, Abidjan, Côte d'Ivoire
| | - Ibrahim Cherif
- Service de néphrologie, CHU de Yopougon, BP 632, Abidjan 21, Côte d'Ivoire
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Abstract
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.
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11
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Le syndrome de la poche à urines violettes. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Llenas-García J, García-López M, Pérez-Bernabeu A, Cepeda J, Wikman-Jorgensen P. Purple urine bag syndrome: A systematic review with meta-analysis. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Lin J, Hlafka M, Vargas O, Bhattarai M. Recurrent purple urine bag syndrome presenting with full spectrum of disease severity: case report and review of literature. CEN Case Rep 2017; 5:144-147. [PMID: 28508966 DOI: 10.1007/s13730-016-0213-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a unique phenomenon characterized by purple discoloration of the urinary catheter bag and tubing following urinary catheterization lasting for hours to days. The purple discoloration is a mixture of indirubin dissolved in plastic with indigo on its surface. PUBS is most commonly associated with urinary tract infection (UTI) caused by bacteria with indoxyl phosphatase/sulfatase activity. It occurs predominantly in chronically catheterized, constipated elderly female patients. It usually appears to be asymptomatic and harmless, but rarely it can present as a severe illness. We report on a 29-year-old female with urinary ileal diversion presenting with multiple episodes of PUBS each with an asymptomatic state of varying severity, symptomatic UTI and severe sepsis requiring intensive care. To our knowledge, this is the first report where a single young patient had recurrent PUBS which presented with a full spectrum of disease severity at different occasions.
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Affiliation(s)
- Junzhi Lin
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA.
| | - Martha Hlafka
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA
| | - Omar Vargas
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA
| | - Mukul Bhattarai
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA
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Agbor VN, Njim T, Oben HB, Aminde LN. Purple Urine Bag Syndrome in an 80-year-old Female Cameroonian. Niger Med J 2017; 58:119-121. [PMID: 29962654 PMCID: PMC6009141 DOI: 10.4103/nmj.nmj_173_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purple urine bag syndrome is a rare clinical entity commonly seen in elderly females with a long-term urinary catheterization. It presents as purple discoloration of the patient's plastic urine bag and tubing. We report the first case of this rare entity from Central Africa. We present the case of an 80-year-old female with purple urine associated with signs of urinary tract infection. Her symptoms resolved after 3 days of intravenous antibiotic treatment and diet modification. Purple urine bag syndrome remains rare, especially in African literature. Awareness of this benign syndrome is necessary for clinicians so as to adequately manage up to and including the associated anxiety.
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Affiliation(s)
| | - Tsi Njim
- Centre for Global Health and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxfordshire, United Kingdom
| | - Helen Bessem Oben
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Leopold Ndemnge Aminde
- Clinical Research Education, Networking and Consultancy, Douala, Littoral, Cameroon.,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
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15
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Koçoğlu H, Yıldırım B, Okuturlar Y, Hurşitoğlu M, Harmankaya Ö. Purple Urine Bag Syndrome in a Male Patient with Chronic Hemodialysis. Balkan Med J 2016; 33:717-718. [PMID: 27994934 DOI: 10.5152/balkanmedj.2016.151140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/24/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hakan Koçoğlu
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Betül Yıldırım
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yıldız Okuturlar
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Hurşitoğlu
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Özlem Harmankaya
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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16
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Tul Llah S, Khan S, Dave A, Morrison AJA, Jain S, Hermanns D. A Case of Purple Urine Bag Syndrome in a Spastic Partial Quadriplegic Male. Cureus 2016; 8:e552. [PMID: 27182466 PMCID: PMC4852186 DOI: 10.7759/cureus.552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purple bag urine syndrome (PUBS) is a benign and unique phenomenon of the urine turning a deep violet color within the urinary catheter tubing and bag. This phenomenon is commonly encountered in patients indicated with long-term catheter placement or, in certain conditions like chronic constipation, alkaline urine, limited ambulation, and, in terms of gender distribution, the female sex, predominates. PUBS gets its name from a unique phenomenon that takes places inside the gut where tryptophan (an amino acid) is metabolized, producing blue and red hues which together emanate a deep violet color. Here, the case of a middle-aged male patient with a suprapubic catheter in situ, following trauma causing spastic partial quadriplegia, is being presented with PUBS due to UTI secondary to Proteus vulgaris. The risk factors, in this case, include chronic constipation and recurrent urinary tract infections (UTIs).
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Affiliation(s)
- Sibghat Tul Llah
- Department of Medicine, School of Medicine, University of Missouri Kansas City
| | - Salman Khan
- Department of Medicine, School of Medicine, University of Missouri Kansas City
| | - Atman Dave
- Medical Education, Saint Luke's Hospital of Kansas City
| | | | - Swapna Jain
- Medical Education, Saint Luke's Hospital of Kansas City
| | - David Hermanns
- Department of Medicine, School of Medicine, University of Missouri Kansas City
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17
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Neweling F, Janssens U. [Purple urine bag syndrome in a patient with bilateral nephrostomy]. Med Klin Intensivmed Notfmed 2015; 111:731-733. [PMID: 26472461 DOI: 10.1007/s00063-015-0103-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/31/2015] [Indexed: 10/22/2022]
Abstract
This article presents a case of purple urine bag syndrome (PUBS) with purple discoloration of urine in a patient with bilateral nephrostomy and acute renal failure. The discoloration of the urine is a product of bacterial metabolism. In principle, PUBS is benign and not of relevance for prognosis. However, it must be taken seriously as an indication for urinary tract infection and treated accordingly. Important for treatment is adequate urologic hygiene and care of urinary catheters for prevention of bacterial contamination as well as avoiding obstipation.
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Affiliation(s)
- F Neweling
- Klinik für Kardiologie, Elektrophysiologie und Rhythmologie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
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Purple Urine Bag Syndrome in Two Elderly Men with Urinary Tract Infection. Case Rep Nephrol 2015; 2015:746981. [PMID: 26351597 PMCID: PMC4553271 DOI: 10.1155/2015/746981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/11/2015] [Indexed: 11/29/2022] Open
Abstract
Purple urine bag syndrome is a rare condition in which purple discoloration of urine inside its collection bag occurs. We describe two illustrative cases. The first patient is an 81-year-old man who was hospitalized for a newly diagnosed lymphoma with acute obstructive renal failure for which a nephrostomy procedure was performed. During the hospitalization, a sudden purple discoloration of the suprapubic catheter urine was noted, while the nephrostomy urine had a normal color. Urine culture from the suprapubic catheter was positive for Pseudomonas aeruginosa and Enterococcus faecalis; urine from the nephrostomy was sterile. The second case is an 80-year-old man who was admitted for heart failure with cardiorenal dilemma and who was started on intermittent hemodialysis. There was a sudden purple discoloration of the urine in the collection bag from his indwelling catheter. He was diagnosed with an E. coli urinary infection and treated with amoxicillin and removal of the indwelling catheter. These two cases illustrate the typical characteristics of purple urine bag syndrome.
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Purple discoloration of the colon found during autopsy: Identification of betanin, its aglycone and metabolites by liquid chromatography-high-resolution mass spectrometry. Forensic Sci Int 2014; 240:e1-6. [PMID: 24787029 DOI: 10.1016/j.forsciint.2014.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/10/2014] [Accepted: 03/15/2014] [Indexed: 02/05/2023]
Abstract
During autopsy of a 38-year-old man the forensic pathologist noted an atypical purple discoloration of the colon membrane. Hypothesis was that the discoloration could have been caused by ingestion of red beetroot. In order to exclude other toxicological causes for this finding and to analytically verify this hypothesis, colon membrane, blood and urine were screened not only for the typical forensically relevant substances but also for the main chromophoric beetroot compounds employing liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Betanin (m/z 551.1495) and its aglycone betanidin (m/z 389.0973) were found in the extracts of colon membrane and urine. Betanin was detected in whole blood, and urinary analysis additionally revealed two metabolites: betanidin glucuronide (m/z 565.1294) and betanidin sulfate (m/z 469.0541) - showing the same fragmentation pattern as betanidin after the characteristic neutral loss of m/z 176.0315 and m/z 79.9554 for glucuronic acid and sulfate, respectively. This is the first time that betacyanins could be analytically confirmed as cause for a purple discoloration of the colon. Urine analysis further revealed that besides betanin itself betanidin phase II metabolites could be detected in human urine.
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Mumoli N, Vitale J, Brondi B, Basile V, Cei M. Purple Urine‐Bag Syndrome in a Department of Medicine. J Am Geriatr Soc 2013; 61:2240-2241. [DOI: 10.1111/jgs.12577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Josè Vitale
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Barbara Brondi
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Valentina Basile
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Marco Cei
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
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Purple urine bag syndrome may not be benign: a case report and brief review of the literature. Case Rep Infect Dis 2013; 2013:863853. [PMID: 23864970 PMCID: PMC3705812 DOI: 10.1155/2013/863853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a rare condition in which there is purple discoloration of the urine with its collecting bag and associated tubing occurs. It is considered a benign condition. We report an unusual case of PUBS in an 87-year-old female from nursing home who had a history of recurrent UTI. She also had a history of ureteral obstruction requiring left nephrostomy tube. She was brought to emergency department with altered mental status which developed five days after the occurrence of purple discoloration of the urinary bag. Her urine culture grew vancomycin-resistant Enterococci (VRE) and Pseudomonas aeruginosa. She died within three days of hospitalization despite intensive care in tertiary center. This case highlights that PUBS may not always be benign and should be approached on a case-by-case basis because it may signal the underlying UTI which might be very difficult to treat. Failure of recognition of this peculiar color early could delay the appropriate intervention leading to fatal complication. This case also represents the rare occurrence of PUBS in the setting of nephrostomy tube.
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Bocrie OJ, Bouchoir E, Camus A, Popitean L, Manckoundia P. Purple urine bag syndrome in an elderly subject. Braz J Infect Dis 2012; 16:597-8. [PMID: 23141971 DOI: 10.1016/j.bjid.2012.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Olivier-Jacques Bocrie
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
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Abstract
Purple urine bag syndrome is characterized by the urinary drainage bag turning purple in patients on prolonged urinary catheterization, especially those in the bedridden state. It is associated with bacterial urinary tract infections caused by indigo-producing and indirubin-producing bacteria, usually affects women, and is associated with alkaline urine, constipation, and a high bacterial load in the urine. Almost all patients with purple urine bag syndrome are catheterized due to significant disability, and the urinary pH is 7.0 or more. In general, intensive treatment with antibiotics is not recommended. Purple urine bag syndrome per se almost always appears to be asymptomatic and harmless. However, caution is needed, because some cases have been reported to show progression to severe disease states, so further research into the morbidity and mortality of this infection is warranted.
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Affiliation(s)
- Yoshiro Hadano
- Department of General Internal Medicine and Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina-ku, Kyoto, Japan
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Asher C, Mavinamane S. A case of purple urine bag syndrome. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Purple urine bag syndrome in rehabilitation. PM R 2010; 2:303-6. [PMID: 20430334 DOI: 10.1016/j.pmrj.2010.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/17/2009] [Accepted: 01/05/2010] [Indexed: 11/22/2022]
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Yang CJ, Lu PL, Chen TC, Tasi YM, Lien CT, Chong IW, Huang MS. Chronic kidney disease is a potential risk factor for the development of purple urine bag syndrome. J Am Geriatr Soc 2009; 57:1937-8. [PMID: 19807795 DOI: 10.1111/j.1532-5415.2009.02445.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Purple urine bag syndrome, not always a benign process. Am J Emerg Med 2009; 27:895-7. [PMID: 19683127 DOI: 10.1016/j.ajem.2009.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 01/25/2009] [Indexed: 11/21/2022] Open
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Liolios AC, Woess E, Lhotta K. Purple urine bag syndrome (PUBS). Clin Kidney J 2008; 1:365-6. [PMID: 25983938 PMCID: PMC4421267 DOI: 10.1093/ndtplus/sfn057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 04/25/2008] [Indexed: 11/14/2022] Open
Affiliation(s)
- Athanasios C Liolios
- Department of Nephrology and Dialysis , Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - Erich Woess
- Department of Nephrology and Dialysis , Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - Karl Lhotta
- Department of Nephrology and Dialysis , Academic Teaching Hospital Feldkirch , Feldkirch , Austria
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Shiao CC, Weng CY, Chuang JC, Huang MS, Chen ZY. Purple urine bag syndrome: a community-based study and literature review. Nephrology (Carlton) 2008; 13:554-9. [PMID: 18771468 DOI: 10.1111/j.1440-1797.2008.00978.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Purple urine bag syndrome (PUBS) is considered as an uncommon phenomenon. This cohort study aimed to figure out the causative factors and the potential risks of PUBS. METHODS We recruited 84 patients with long-term urinary catheterization from seven nursing institutions and home care centre, then compared the differences of demographic, clinical, urine test and bacteriological data between the patients with and without PUBS. RESULTS The 2-month period prevalence of PUBS in chronic catheterized patients was 16.7%. PUBS-affecting patients had significantly higher proportion of female gender (P = 0.034), self oral intake (P = 0.036) and eating self-prepared food (P = 0.007). Otherwise, no statistical associations were found. Five different bacterial species were isolated from the urine of PUBS-affecting patients. No sequelae were found after forward follow-up for 6 months. We further discuss the associations between certain factors and PUBS according to literature review and the results of our study. CONCLUSION PUBS is not as rare as we thought before. The causative factors of PUBS have not been clearly characterized. It may be the combination of several factors that cause the PUBS. Female gender and food content were found to be associated factors of PUBS in our study. Asymptomatic PUBS is unnecessary to be treated by antibiotics.
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Affiliation(s)
- Chih-Chung Shiao
- Department of Nephrology, Lotung St Mary's Hospital, I-Lan, Taiwan
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Muneoka K, Igawa M, Kurihara N, Kida J, Mikami T, Ishihara I, Uchida J, Shioya K, Uchida S, Hirasawa H. [Biochemical and bacteriological investigation of six cases of purple urine bag syndrome (PUBS) in a geriatric ward for dementia]. Nihon Ronen Igakkai Zasshi 2008; 45:511-519. [PMID: 19057104 DOI: 10.3143/geriatrics.45.511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Purple urine bag syndrome is a condition in which the urinary catheter bag turns purple. A tryptophan-indigo hypothesis has been proposed as the mechanism of PUBS, in which bacterial decomposition of tryptophan in gut associated with chronic constipation, bacterial overgrowth in the urinary tract and alkaline urine causes production of indigo and discoloration. We considered that further investigation of cases was needed. METHODS We investigated 6 cases exhibiting PUBS (3 males and 3 females). RESULTS All cases had chronic constipation. Oral ingestion was impossible in one case. PUBS disappeared after antibiotic treatment (3 cases) or spontaneously (one case). Alkaline urine and indicanuria were not found in all cases that showed the disappearance of PUBS. In bacterial culture of urine during the exhibition of PUBS, Enterococcus faecalis was isolated together with Morganella morganii (3 cases) and Pseudomonas aeruginosa (one case). Single infections by Klebsiella pneumoniae or Citrobacter species were also found. After disappearance of PUBS, infected bacterial species changed but no cases showed sterile urine. Urine and blood alpha-amino-n-butyric acid levels reduced after the disappearance of PUBS whereas tryptophan levels did not show related changes. In one case, blood protein concentration increased after the spontaneous disappearance of PUBS. Indicanuria and alkalization of urine from urinary catheter bag were more intense than of fresh urine. CONCLUSIONS The present results generally support the 'Tryptophan-indigo hypothesis'. Furthermore, it was suggested that additional factors associated with the occurrence of PUBS are an environment that facilitates specific bacterial growth in a hospital as well as abnormal metabolism relating to alpha-amino-n-butyric acid and reduced protein synthesis in patients.
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Pillai RN, Clavijo J, Narayanan M, Zaman K. An association of purple urine bag syndrome with intussusception. Urology 2007; 70:812.e1-2. [PMID: 17991574 DOI: 10.1016/j.urology.2007.07.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 04/23/2007] [Accepted: 07/12/2007] [Indexed: 11/19/2022]
Abstract
We report a case of an elderly lady with a long-term suprapubic catheter who developed purple discoloration of urine around the same time as she developed intussusception. Purple urine bag syndrome is a benign condition known to be associated with intestinal stasis. However, this association with intussusception should be kept in mind before the patient is reassured.
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Ga H, Park KH, Choi GD, Yoo BI, Kang MC, Kim SM, Lee EJ, Park ST, Park CH. PURPLE URINE BAG SYNDROME IN GERIATRIC WARDS: TWO FACES OF A COIN? J Am Geriatr Soc 2007; 55:1676-8. [PMID: 17908069 DOI: 10.1111/j.1532-5415.2007.01327.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Su YJ, Lai YC, Chang WH. Purple urine bag syndrome in a dead-on-arrival patient: case report and articles reviews. Am J Emerg Med 2007; 25:861.e5-6. [PMID: 17870510 DOI: 10.1016/j.ajem.2007.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 02/04/2007] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Medical Center, Taipei 10449, Taiwan, ROC.
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Lazimy Y, Delotte J, Machiavello JC, Lallement M, Imbenotte M, Bongain A. [Purple urine bag syndrome: a case report]. Prog Urol 2007; 17:864-5. [PMID: 17634003 DOI: 10.1016/s1166-7087(07)92322-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The authors report a case of dark purple urine in a woman with bowel obstruction and bilateral percutaneous nephrostomy urinary diversion for 30 years. This colour was due to the presence of high urinary concentrations of 3-indoxyl sulphate due to the enzymatic activity of Providencia rettgeri. A favourable course was observed in response to antibiotics.
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Affiliation(s)
- Yaël Lazimy
- Service de Gynécologie-Obstétrique-Reproduction et de Médecine Foetale, CHU de Nice
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Rohaut B, Bachmeyer C, Lecomte I, Ravet N, Grateau G. [A urine bag turns purple]. Rev Med Interne 2005; 26:666-7. [PMID: 16054519 DOI: 10.1016/j.revmed.2005.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 02/03/2005] [Indexed: 11/25/2022]
Affiliation(s)
- B Rohaut
- Service de médecine interne, hôpital Tenon, 4, rue De-la-Chine, 75020 Paris, France
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Abstract
The purple urine bag syndrome (PUBS) is a rare condition associated with chronic urinary catheterization. It is characterized by the purple discoloration of the urine, collecting bag, and tubing. A number of factors are involved, but not always present, in its development including female sex, urinary tract infection, constipation, indicanuria, and alkaline urine. Despite multiple theories that involve the complex tryptophan metabolism to the tubing dye, the cause remains elusive. The syndrome resolves usually after treatment of urinary tract infection or changing of the collecting bag. We present a case of a patient with purple urine bag syndrome and a pertinent literature review.
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