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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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Muacevic A, Adler JR. Purple Urine Bag Syndrome: A Rare and Surprising Clinical Presentation. Cureus 2023; 15:e33354. [PMID: 36751160 PMCID: PMC9897695 DOI: 10.7759/cureus.33354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Purple urine bag syndrome (PUBS) is a rare finding that can be very alarming to patients and physicians. PUBS has a simple visual diagnosis with clinical symptoms that can aid in a quick and appropriate treatment plan. However, a lack of physician awareness could be harmful to the patient and cause unnecessary treatment and increased morbidity and financial burden to the patient. We present a case with this surprising finding and discuss the pathophysiology and management options for this rare syndrome.
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Hien S, Bonzi YJ, Sawadogo A, Yanogo M, Mande AR, Coulibaly G. [Purple urine bag syndrome (PUBS): about two cases at the Regional University Hospital Center (CHUR) of Ouahigouya]. Pan Afr Med J 2021; 38:284. [PMID: 34122711 PMCID: PMC8179976 DOI: 10.11604/pamj.2021.38.284.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/28/2021] [Indexed: 11/30/2022] Open
Abstract
Phénomène rare survenant le plus souvent chez des patients âgés constipés, porteurs de sonde urinaire chronique et en alitement prolongé, le syndrome de la poche à urine violette traduit généralement une infection du tractus urinaire. Plusieurs bactéries appartenant à deux groupes à la fois (groupe transformant l'indoxyl sulfate urinaire en indoxyl et groupe susceptible d'alcaliniser les urines par la production d'uréase) seraient en cause. Nous décrivons 2 cas au Burkina Faso chez des patientes jeunes de 30 et 16 ans en encéphalopathie urémique avec syndrome infectieux sévère ayant présenté des urines troubles avec une coloration violette de la poche collectrice. Contrairement aux séries rapportées dans la littérature, nos cas sont survenus après les deuxième et quatrième jours de sondage vésical et sur des patientes jeunes sans notion de constipation. Et malgré une antibiothérapie précoce, l´évolution a été défavorable chez une patiente.
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Affiliation(s)
- Siébou Hien
- Service de Médecine Générale, Centre Hospitalier Universitaire Régional de Ouahigouya, Ouahigouya, Burkina Faso
| | - Yérémadé Juste Bonzi
- Service de Néphrologie et d'Hémodialyse, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Amidou Sawadogo
- Service de Néphrologie et d'Hémodialyse, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | - Moussa Yanogo
- Service de Médecine Générale, Centre Hospitalier Universitaire Régional de Ouahigouya, Ouahigouya, Burkina Faso
| | - Abibata Rachel Mande
- Service de Médecine Générale, Centre Hospitalier Universitaire Régional de Ouahigouya, Ouahigouya, Burkina Faso
| | - Gérard Coulibaly
- Service de Néphrologie et d'Hémodialyse, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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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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Gulmez MD, Yildirim O, Soyhan M, Uslu S, Usoglu B, Karamancı E, Yüksel A, Tatar E. Purple urine: an astonishing symptom in an elderly patient with acute kidney injury. Intern Med J 2019; 49:677-679. [PMID: 31083799 DOI: 10.1111/imj.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Meltem D Gulmez
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ozden Yildirim
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Merve Soyhan
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Serhan Uslu
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Berkant Usoglu
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ege Karamancı
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Arif Yüksel
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Erhan Tatar
- Department of Nephrology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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6
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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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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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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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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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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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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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Richardson-May J. Single case of purple urine bag syndrome in an elderly woman with stroke. BMJ Case Rep 2016; 2016:bcr2016215465. [PMID: 27489067 PMCID: PMC4985987 DOI: 10.1136/bcr-2016-215465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2016] [Indexed: 11/04/2022] Open
Abstract
Purple urine bag syndrome is an unusual condition that heralds an underlying urinary tract infection, in which certain bacteria produce a purple discolouration within the catheter bag of affected cases. It is most often seen in elderly women with constipation. While alarming, it can be resolved by treating the infection causing it. This report presents an elderly patient who developed the condition while an inpatient, and discusses the pathogenesis behind the condition.
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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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