1
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Lima JVF, da Costa MDS, Cavalheiro S. "The blue catheter" - case report. Childs Nerv Syst 2024; 40:1949-1951. [PMID: 38427107 DOI: 10.1007/s00381-024-06330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
The ventriculoperitoneal shunt placement procedure is common throughout the world, with a prevalence of approximately 30,000 procedures per year in the United States (5). However, the rate of complications is still important and must be remembered, with a percentage of 11 to 25% after the first year of implantation. Abdominal complications are described in 5-47% of the cases (6), and the abdominal pseudocyst is one of them. We present the case of a patient colonized by multidrug-resistant bacteria, who underwent exteriorization surgery of a ventriculoperitoneal shunt. Intraoperatively, a blue coloration was observed in the catheter, a phenomenon previously described in urinary infections (1)(2) but not before in pathologies of the central nervous system. Our objective is to present an atypical case of dysfunction of the ventriculoperitoneal shunt, whose diagnosis couldbe evidenced through the coloration of the catheter exteriorized in surgery.
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Affiliation(s)
- J V F Lima
- Federal University of São Paulo, São Paulo, Brazil.
| | | | - S Cavalheiro
- Federal University of São Paulo, São Paulo, Brazil
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2
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Pereira AP, Camarinha I, Ferreira A, Sevivas H, Reis M. Purple Urine Bag Syndrome: A Rare Phenomenon Managed in Primary Care. Cureus 2024; 16:e57620. [PMID: 38707090 PMCID: PMC11069420 DOI: 10.7759/cureus.57620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
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.
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Affiliation(s)
- António P Pereira
- Family Medicine, USF Ruães, Unidade Local de Saúde de Braga, Braga, PRT
| | - Isabel Camarinha
- Family Medicine, USF Ruães, Unidade Local de Saúde de Braga, Braga, PRT
| | - Adriana Ferreira
- Family Medicine, USF Ruães, Unidade Local de Saúde de Braga, Braga, PRT
| | - Hugo Sevivas
- Family Medicine, USF Ruães, Unidade Local de Saúde de Braga, Braga, PRT
| | - Mariana Reis
- Family Medicine, USF Ruães, Unidade Local de Saúde de Braga, Braga, PRT
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3
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Shaik MR, Shaik NA, Hossain S, Yunasan E, Khachatryan A, Chow R. Purplish Discoloration of Urine in a Patient Receiving Cefiderocol: A Rare Adverse Effect. J Community Hosp Intern Med Perspect 2023; 13:43-46. [PMID: 38596538 PMCID: PMC11000853 DOI: 10.55729/2000-9666.1256] [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: 05/07/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Drug-induced urine discoloration, although usually benign, can still raise concern in healthcare facilities. This case report presents the second case of purple urine discoloration associated with cefiderocol in a 64-year-old male admitted to the intensive care unit for ventilator-associated pneumonia. The patient required broad-spectrum antibiotic treatment with vancomycin, cefiderocol, amikacin, and micafungin. On the fourth day after initiating antibiotics, the presence of purplish urine in the foley bag was noted. Urinalysis showed 11-25 red blood cells/hpf, but cultures ruled out urinary tract infection. Further laboratory workup did not reveal any evidence of hemolysis or rhabdomyolysis. Cultures from the endotracheal aspirate grew multidrug-resistant Pseudomonas. Cefiderocol and amikacin were continued to complete a seven-day course. Two days after completion of the cefiderocol course, the urine discoloration cleared up, providing strong evidence that cefiderocol was the cause of the discoloration.
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Affiliation(s)
- Mohammed R. Shaik
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
| | - Nishat A. Shaik
- Department of Medicine, Guntur Medical College, Guntur, Andhra Pradesh,
India
| | - Sarah Hossain
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
| | - Elvina Yunasan
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
| | - Aleksan Khachatryan
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
| | - Robert Chow
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,
United States
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4
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Kannan L, Bauman AA. Purple urine in a patient with UTI and constipation. Oxf Med Case Reports 2023; 2023:omad013. [PMID: 36860965 PMCID: PMC9969816 DOI: 10.1093/omcr/omad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
Purple urine bag syndrome (PUBS) is a visually striking and a rare side effect in a patient with urinary tract infection where urine in the catheter bags and tubing turn purple. The urine in PUBS gets its color from the combination of two pigments, indirubin and indigo, which are breakdown products of tryptophan. The most important risk factors include long-term catheterization, female gender, chronic constipation, old age and being bed bound. Here, we present a case of PUBS in an elderly female with a history of bladder cancer that needed catheterization along with constipation.
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Affiliation(s)
- Lakshmi Kannan
- Corresponding Author: Lakshmi Kannan, Department of Internal Medicine, Division of Nephrology, Adjunct Clinical Faculty, Pikeville Medical Center/University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Kentucky- 41501. E-mail: , Tel: 804-325-7540
| | - Allison Ann Bauman
- Department of Nephrology, Pikeville Medical Center, Pikeville, KY, USA,University of Pikeville Kentucky College of Osteopathic Medicine, OMS IV, Pikeville, Kentucky, USA
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5
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Agrawal A, Pande T, Tripathy S. Purple urinary bag syndrome: Our experience. Med J Armed Forces India 2023; 79:21-25. [PMID: 36605349 PMCID: PMC9807677 DOI: 10.1016/j.mjafi.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/28/2020] [Indexed: 01/09/2023] Open
Abstract
Background Purple urinary bag syndrome (PUBS) is a visually striking and rare manifestation of urinary tract infection characterised by purple discolouration of the catheter and the urobag, which are seen primarily in patients who are on long-term indwelling catheter. This rare syndrome results due to the breakdown of indole, a by-product of dietary tryptophan metabolism, to coloured pigments indigo and indirubin by urinary bacteria, which reacts with the catheter and the bag to impart a purple colour. Methods This was a prospective observational study, wherein all cases of PUBS diagnosed between March 2012 and February 2020 were analysed and followed up. Results A total of five patients were presented with PUBS. Among them, four were women, and four were chronically constipated. All of them were elderly and debilitated with either being bed bound or having restricted mobility. Three of them had associated chronic kidney disease. All of them were treated successfully with change of catheters and antibiotics. Conclusion This rare but alarming condition occurs in elderly patients who are on long-term indwelling catheters. The diagnosis is visually apparent, and the treatment may be just a simple change of catheter with oral antibiotics. The awareness may help in correct diagnosis and treatment.
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Affiliation(s)
- Amit Agrawal
- Senior Adviser (Surgery) & Urologist, Command Hospital (Western Command), Chandimandir, India
| | - Tanmay Pande
- Graded Specialist (Surgery), 308 Field Hospital, C/o 56 APO, India
| | - S. Tripathy
- Classified Specialist (Surgery) & Urologist, Command Hospital (Eastern Command), Kolkata, India
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6
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Ahmed SI, Waheed MA, Shah S, Muhammad Shah SY, Mumtaz H. Purple urine bag syndrome: A case report. Int J Surg Case Rep 2022; 99:107721. [PMID: 36261954 PMCID: PMC9568877 DOI: 10.1016/j.ijscr.2022.107721] [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: 09/03/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Purple Urine Bag Syndrome (PUBS) is purple discoloration of urine and is common in bedridden patients with long-term urinary catheter. Although typically benign, the purple discoloration is alarming to both the patients and their attendants. CASE REPORT This case report presents an uncommon case of PUBS in a 74-year-old lady with hypertension, type II diabetes and ischemic stroke from last 2 years. She has neurogenic bladder and has been catheterized from last 2 years. Her last catheter was changed 15 days back. She presented to the emergency room with complaints of change in color of urine with low grade fever from last 1 week. on clinical examination there was one bed sore on lumbar region that was grade 1 with pus oozing from base of ulcer. CLINICAL DISCUSSION PUBS is generally associated with alkaline urine and in patients who was chronically catheterized as was observed in this patient, although it has also been reported in acidic urine. CONCLUSION PUBS is a rare manifestation of urinary tract infection with an alarming appearance and can be a source of anxiety for patients and their families. Being asymptomatic and comparatively benign, purple discoloration is simply an indicator of underlying bacteriuria and is of no prognostic value.
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Affiliation(s)
| | - Mir Abdul Waheed
- Emergency Medicine, Maroof International Hospital, Islamabad, Pakistan
| | - Sara Shah
- Emergency Medicine, Maroof International Hospital, Islamabad, Pakistan
| | | | - Hassan Mumtaz
- Maroof International Hospital, Islamabad, Pakistan,Health Services Academy, Islamabad, Pakistan,Corresponding author at: Maroof International Hospital, Islamabad, Pakistan.
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7
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Use of Raman Spectroscopy, Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy in a Multi-Technique Approach for Physical Characterization of Purple Urine Bag Syndrome. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12084034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purple urine bag syndrome (PUBS) is a rare condition characterized by purple discoloration of urine and urine bags. Although it is benign, it represents an alarming symptom to the patients and their relatives because of purple discoloration. We have physically characterized urine and urine bags belonging to a patient suffering from PUBS using an approach that combines Raman spectroscopy (RS) and scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX). Five “blue” discolored bags and one sterile urine bag, representing the control, were cut into 1 cm2 square samples and analyzed by using RS and SEM + EDX technique. RS enabled us to identify the presence of indigo, a metabolite of tryptophan, while SEM analysis showed the biofilm deposit, probably due to the presence of microorganisms, and the EDX measurements exhibited the elemental composition of the bags. In particular, urine bags before and after the presence of PUBS urine showed an increase of ~32% of Cl, ~33% of O, ~667% of Ca, ~65% of Al and Mg, while C decreased by about 41%. Our results, to be taken as a proof-of-principle study, are promising for the aim to characterizing the urine bags in a flexible, inexpensive, and comprehensive manner.
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8
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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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9
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Sriperumbuduri S, Brown PA, Clark EG. Purple Urine in a Patient with Refractory Hypotension. KIDNEY360 2021; 2:598-599. [PMID: 35369009 PMCID: PMC8786003 DOI: 10.34067/kid.0005362020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Sriram Sriperumbuduri
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Pierre-Antoine Brown
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada,Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada,Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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10
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Abstract
This contribution presents a literature review of therapeutic patient education and a summary of an oral presentation given by two wound care specialists at a recent European Congress. It relates these to models of care in nursing science and other research that contributes to this approach at the core of healthcare practice.
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Affiliation(s)
- Laurence Lataillade
- Laurence Lataillade, CNS, is Stomatherapist, Geneva University Hospitals, Switzerland. Laurent Chabal, BSc (CBP), RN, OncPall (Cert), Dip (WH), ET, EAWT, is Stomal Therapy Nurse and Lecturer, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland. Acknowledgment: The wound section of this article was partially based on notes taken during the University Conference Model session that took place at the 2017 Congress of the European Wound Management Association in Amsterdam, the Netherlands presented by Julie Jordan O'Brien, Clinical Nurse Specialist Tissue Viability and Véronique Urbaniak, Advanced Practice Nurse. The authors have disclosed no financial relationships related to this article. This article was originally published as Lataillade L, Chabal L. Therapeutic patient education; a multifaceted approach to healthcare. WCET J 2020;40(2):35-42. © Advances in Skin and Wound Care and World Council of Enterostomal Therapists
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11
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Verma S, Barwal KC, Singh D, Sharma V, Shrivastava M. Purple Urine Bag Syndrome: a Rare Benign Condition Associated with Chronic Indwelling Urinary Catheter and Bacterial Infection in an Elderly Man. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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12
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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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13
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Abstract
Purple urine bag syndrome (PUBS) is a rare phenomenon in patients that is associated with the use of a long-term/indwelling urinary catheter. The purple color results from indigo and indirubin, accumulated from bacteria-mediated tryptophan conversion. High risk patients include: the elderly; women; immobilized patients; patients with an indwelling catheter, chronic constipation, alkaline urine or poor hygiene; and those with catheter bags and tubes made of certain types of plastic. We reported PUBS in an elderly woman with an indwelling catheter and chronic constipation which, to our knowledge, was the first case in our hospital. The patient underwent urinary catheter change and received intravenous ciprofloxacin, following which the urine returned to a yellow color and the patient was discharged. This case report describes the diagnosis, management and also strategies for the prevention of PUBS in Gatot Soebroto Army Hospital, Indonesia.
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Affiliation(s)
- Senohadi Boentoro
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jalan Diponegoro 71, Jakarta, 10430, Indonesia
| | - Nugroho Budi Utomo
- Gatot Soebroto Army Hospital, Jalan Abdul Rahman Saleh 24, Jakarta, 10410, Indonesia
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14
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Kumar D, Donga N, Macwan R. Purple Urine Bag Syndrome: A Scary but Easily Manageable Condition in a Patient with Prolonged indwelling Urinary Catheter. Indian J Palliat Care 2018; 24:534-536. [PMID: 30410271 PMCID: PMC6199850 DOI: 10.4103/ijpc.ijpc_88_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
“Purple urine bag syndrome” (PUBS) is a rare but distressing presentation of urinary tract infection (UTI) among moribund patients on indwelling urinary catheter. A 56-year-old woman with carcinoma of the left breast and metastasis in vertebrae and liver was bed ridden. She was on Foley's catheter for 9 months, with the last catheter changed 3 weeks back. A 75-year-old woman presented with non-Hodgkin's lymphoma for 2 years and moderately differentiated squamous cell carcinoma of the right parotid region (8 months). She experienced fall and fracture of femur, bed ridden, and on Foley's catheter for 7 years. She had facial wound with maggots for 3 days. Both the women developed purple-colored urine with no other symptoms of UTI. No investigations were carried out and they were empirically treated with nitrofurantoin, catheter change reassurance, and increased fluid intake. Urine color was normal by a week. PUBS can be managed easily at home with simple antibiotics, adequate hydration, and family/patient counseling in palliative care settings.
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Affiliation(s)
- Dinesh Kumar
- Department of Community Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Namrata Donga
- Department of Palliative Care, Shree Krishna Hospital, Karamsad, Gujarat, India
| | - Rekha Macwan
- Department of Palliative Care, Shree Krishna Hospital, Karamsad, Gujarat, India
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15
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Ito WE, Maia de Almeida SH. Purple urine-bag syndrome. Int Urogynecol J 2018; 30:157-158. [PMID: 30121704 DOI: 10.1007/s00192-018-3747-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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16
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Pandey S, Pandey T, Sharma A, Sankhwar S. Purple urinary bag syndrome: what every primary healthcare provider should know. BMJ Case Rep 2018; 2018:bcr-2018-226395. [PMID: 30021748 DOI: 10.1136/bcr-2018-226395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tushar Pandey
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Sharma
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyanarayan Sankhwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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17
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Karray O, Batti R, Talbi E, Ayed H, Chakroun M, Ouarda MA, Bouzouita A, Cherif M, Ben Slama MR, Amel M, Abdelmoula J, Derouiche A, Chebil M. Purple urine bag syndrome, a disturbing urine discoloration. Urol Case Rep 2018; 20:57-59. [PMID: 29992092 PMCID: PMC6034577 DOI: 10.1016/j.eucr.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Omar Karray
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Rym Batti
- Oncology Department, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Emna Talbi
- Biochemistry Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Haroun Ayed
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Marouene Chakroun
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mouna Ayadi Ouarda
- Oncology Department, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Abderrazek Bouzouita
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Cherif
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Riadh Ben Slama
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mezlini Amel
- Oncology Department, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Jouida Abdelmoula
- Biochemistry Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Amine Derouiche
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Chebil
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
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18
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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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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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Abstract
Purple urine bag syndrome is an uncommon condition that describes the purple discolouration of a catheter bag and tubing. It mainly affects patients with limited mobility who have long-term catheters. Although benign in nature per se, its presence can alarm both patient and practitioner unfamiliar with the syndrome. Here, we describe two cases of asymptomatic patients who both presented to outpatient clinic with the characteristic purple discolouration of their long-term catheters and tubing. The report discusses the pathophysiology of the syndrome and initial investigation and management. Although the syndrome is considered benign, it may signify occult urine tract infection. This should not be ignored even if the patient is asymptomatic, given the likely co-morbidities of the patients affected. Healthcare professionals - particularly urologists and geriatricians - need to be aware of this unusual syndrome so as to initiate appropriate investigation and possible treatment as soon as possible.
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Affiliation(s)
- H Rooney
- 1 Core Surgical Trainee, Monklands General Hospital, UK
| | - L Mokool
- 2 Urology Registrar, Monklands General Hospital, UK
| | - A Ramsay
- 3 Urology Consultant, Monklands General Hospital, UK
| | - S Nalagatla
- 3 Urology Consultant, Monklands General Hospital, UK
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Sagar S, Narasimhaswamy N, D'Souza J. Providencia Rettgeri: An Emerging Nosocomial Uropathogen in an Indwelling Urinary Catheterised Patient. J Clin Diagn Res 2017; 11:DD01-DD02. [PMID: 28764161 DOI: 10.7860/jcdr/2017/25740.10026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/20/2017] [Indexed: 11/24/2022]
Abstract
Providencia rettgeri (P. rettgeri) is an ubiquitous organism but is seldom associated with human disease. We report the isolation of P. rettgeri from the urine sample of a 39-year-old male patient on prolonged Foley's catheterisation following a severe head injury. Identification of this organism was done by Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF) based systems. P. rettgeri is an emerging pathogen among long term catheterised patients. It reflects its ability to form biofilm on the surface of the indwelling catheter as well as the inherent urease producing property of the pathogen in question as a possible mechanism of pathogenesis.
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Affiliation(s)
- Siddharth Sagar
- Postgraduate Student, Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Nagalakshmi Narasimhaswamy
- Assistant Professor, Department of Microbiology, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India
| | - Jessica D'Souza
- Selection Grade Lecturer, Department of Microbiology, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India
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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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Karim A, Abed F, Bachuwa G. A unilateral purple urine bag syndrome in a patient with bilateral nephrostomy tubes. BMJ Case Rep 2015; 2015:bcr-2015-212913. [PMID: 26701992 DOI: 10.1136/bcr-2015-212913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A change in the colour of urine is always of clinical significance, and a source of concern for the patient and his physician. Among the different urine colours observed, purple is the least common. Although purple discolouration of a catheter and a urine bag is an uncommon finding, it was reported in the literature as early as 1978, by Barlow and Dickson. We present a unique case of purple urine bag syndrome in a patient with bilateral nephrostomy tubes (NT) and associated urine bags (UB) with only the left nephrostomy tube and urine bag exhibiting the purple colour, which resolved with a course of appropriate antibiotics eradicating the causative bacterial pathogen, and change of NT and UB.
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Affiliation(s)
- Adil Karim
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Firas Abed
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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Abubacker NRT, Jayaraman SMT, R K, Sivanesan MK, Mathew R. Purple Urine Bag Syndrome. J Clin Diagn Res 2015; 9:OD01-2. [PMID: 26435987 PMCID: PMC4576580 DOI: 10.7860/jcdr/2015/14736.6304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 11/24/2022]
Abstract
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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Affiliation(s)
- Naufal Rizwan Taraganar Abubacker
- Assistant Professor, Department of General Medicine, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, India
| | | | - Kannan R
- Associate Professor, Department of General Medicine, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, India
| | - Magesh Kumar Sivanesan
- Professor, Department of General Medicine, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Tamil Nadu, Chennai, Tamil Nadu, India
| | - Renu Mathew
- Professor, Department of Microbiology, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, India
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Abstract
Purple urine bag syndrome occurs commonly in long-term catheterized patients causing significant stress for patients, care takers, and health care providers. This may lead to unwarranted investigation as well as treatment when not identified early. Demographic changes in Indian population with increasing geriatric care make it a case to increase awareness of this condition among health care providers in primary and secondary care settings.
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Affiliation(s)
- Reginald Alex
- Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Krishna Manjunath
- Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajan Srinivasan
- Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gopal Basu
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Ungprasert P, Ratanapo S, Cheungpasitporn W, Kue-A-Pai P, Bischof EF. Purple urine bag syndrome. Clin Kidney J 2013; 6:344. [PMID: 26064500 PMCID: PMC4400471 DOI: 10.1093/ckj/sft016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 11/21/2022] Open
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Meekins PE, Ramsay AC, Ramsay MP. Purple urine bag syndrome. West J Emerg Med 2013; 13:499-500. [PMID: 23359394 PMCID: PMC3555583 DOI: 10.5811/westjem.2012.3.12119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 03/26/2012] [Indexed: 11/11/2022] Open
Affiliation(s)
- Pauline E Meekins
- Medical University of South Carolina, Division of Emergency Medicine, Charleston, South Carolina
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Cooksey CJ. An annotated bibliography of recent significant publications on indigo and related compounds. Biotech Histochem 2012; 87:439-63. [DOI: 10.3109/10520295.2012.698308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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