Purple urine bag syndrome: a unique clinical case and management considerations

Abstract Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial en...

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Main Authors: Fatemeh Mahdi, Amirhossein Larijani
Format: Article
Language:English
Published: BMC 2024-10-01
Series:BMC Nephrology
Subjects:
Online Access:https://doi.org/10.1186/s12882-024-03708-6
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author Fatemeh Mahdi
Amirhossein Larijani
author_facet Fatemeh Mahdi
Amirhossein Larijani
author_sort Fatemeh Mahdi
collection DOAJ
description Abstract Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora breaks down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes are present. The breakdown products, indigo, and indirubin appear blue and red. We reported on an elderly woman who was kept in a nursing home, had multiple comorbidities such as history of cerebrovascular accident (CVA), acute kidney injury (AKI) and she was hospitalized due to decreased consciousness, fever and kidney failure. On the third day of hospitalization, the patient developed PUBS while undergoing urinary catheterization in the hospital. She had no history of previous catheterization and chronic use of antibiotics, she was only using Tolterodine for a long time due to urinary urgency. Due to antibiotic resistance, the drugs were not changed and the purple color disappeared after changing the catheter and urinary bag. This was the first patient in this region to be reported with this manifestation.
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spelling doaj-art-4af30c0daeb74bb4b6d034cbeec055bd2025-08-20T02:11:24ZengBMCBMC Nephrology1471-23692024-10-012511410.1186/s12882-024-03708-6Purple urine bag syndrome: a unique clinical case and management considerationsFatemeh Mahdi0Amirhossein Larijani1Department of Internal Medicine, School of Medicine, Guilan University of Medical SciencesStudent Research Committee, School of Medicine, Guilan University of Medical SciencesAbstract Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora breaks down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes are present. The breakdown products, indigo, and indirubin appear blue and red. We reported on an elderly woman who was kept in a nursing home, had multiple comorbidities such as history of cerebrovascular accident (CVA), acute kidney injury (AKI) and she was hospitalized due to decreased consciousness, fever and kidney failure. On the third day of hospitalization, the patient developed PUBS while undergoing urinary catheterization in the hospital. She had no history of previous catheterization and chronic use of antibiotics, she was only using Tolterodine for a long time due to urinary urgency. Due to antibiotic resistance, the drugs were not changed and the purple color disappeared after changing the catheter and urinary bag. This was the first patient in this region to be reported with this manifestation.https://doi.org/10.1186/s12882-024-03708-6Purple urine bag syndromePurple urine
spellingShingle Fatemeh Mahdi
Amirhossein Larijani
Purple urine bag syndrome: a unique clinical case and management considerations
BMC Nephrology
Purple urine bag syndrome
Purple urine
title Purple urine bag syndrome: a unique clinical case and management considerations
title_full Purple urine bag syndrome: a unique clinical case and management considerations
title_fullStr Purple urine bag syndrome: a unique clinical case and management considerations
title_full_unstemmed Purple urine bag syndrome: a unique clinical case and management considerations
title_short Purple urine bag syndrome: a unique clinical case and management considerations
title_sort purple urine bag syndrome a unique clinical case and management considerations
topic Purple urine bag syndrome
Purple urine
url https://doi.org/10.1186/s12882-024-03708-6
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