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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 86-87

Purple urine bag syndrome: An uncommon but noteworthy phenomenon in the ward


Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission27-Apr-2020
Date of Acceptance14-May-2020
Date of Web Publication14-Jul-2020

Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MTSM.MTSM_10_20

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How to cite this article:
Pangtey T, Dharmshaktu GS. Purple urine bag syndrome: An uncommon but noteworthy phenomenon in the ward. Matrix Sci Med 2020;4:86-7

How to cite this URL:
Pangtey T, Dharmshaktu GS. Purple urine bag syndrome: An uncommon but noteworthy phenomenon in the ward. Matrix Sci Med [serial online] 2020 [cited 2020 Sep 27];4:86-7. Available from: http://www.matrixscimed.org/text.asp?2020/4/3/86/289728



The abnormal discoloration of urine or container bag is visually striking phenomenon and may put patient and relatives into unwanted apprehension. The cases with purple discoloration of the urine are sporadically reported in the literature. This unusual but well described phenomenon is termed purple urine bag syndrome (PUBS). Prolonged indwelling catheterization in some cases results in this peculiar condition.[1]

An elderly destitute lady admitted in the ward for multiple fractures had been catheterized by the urinary catheter to prevent frequent bed soiling. After 7 days, the nursing staff noticed her urine bag containing urine with unusual hue [Figure 1]. The patient, however, had no related clinical problems. The images of the urinary bag are given below. Her routine blood investigation, lipid profile, liver function tests, and renal function tests were unremarkable except mild raised serum creatinine. The rise was attributed to less water intake and dehydration, which was corrected by intravenous fluid therapy to normal levels within 2 days. There was no history of any drug intake other than occasional pain medication along with a negative history of any chronic systemic disorders. There was no clinical feature, suggesting urinary or systemic infection along with negative history for any chronic comorbidity. The catheter was removed, and the content was sent along with tip of the catheter for bacteriological examination which yielded no organism. The intermittent catheterization was encouraged, and the patient continued that till her stay following fracture surgeries. The antibiotics received in the postoperative protocols might have worked upon any undetected urinary tract infection (UTI). Nonweight bearing ambulation was started after the surgery, and requirement of catheterization was subsequently diminished. There was no complications noted the follow-up.
Figure 1: The clinical image of the urinary bag with purple discoloration of urine suggestive of purple urinary bag syndrome

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The prolonged hospitalization, catheterization, and the presence of UTIs predispose to PUBS. Females and alkalinity of the urine are more linked to this disorder.[2] Tryptophan metabolites indoxyl that turns indigo (blue color) and when mixes with indirubin (red color) turns urine purple.[3] Chronic constipation, by increased tryptophan metabolism due to bacterial overgrowth favors PUBS along with sulphatase-phsophatase-producing bacteria.[4] This is largely a benign condition, and most cases do not have remote complications. The symptomatic and supportive treatment such as urological hygiene, treatment of constipation, increased water intake, frequent changing, or intermittent catheterization is sufficient in most cases.[5] The prevention and treatment of UTI and constant vigil to rule out concurrent disorders is also required. On rare instances, PUBS can be forerunner of serious complications such as fulminant infection or abscess in adjacent structures.[6] Constant vigil thus is required in these cases as many cases might have associated renal failure during the period or PUBS may be an indicator for the same. The patient and relatives also require proper guidance to alleviate their concerns. This unusual presentation should be acknowledged and taught to hospital staff, and proper documentation is important. More cases and good studies are required to more comprehensively know about their prevalence, complications, or prognosis in the general population.

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khan F, Chaudhry MA, Qureshi N, Cowley B. Purple urine bag syndrome: An alarming hue? A brief review of the literature. Int J Nephrol 2011;2011:419213.  Back to cited text no. 1
    
2.
Lin CH, Huang HT, Chien CC, Tzeng DS, Lung FW. Purple urine bag syndrome in nursing hmes: Ten elderly case reports and a literature review. Clin Interv Ageing 2008;3:729-34.  Back to cited text no. 2
    
3.
Lin HH, Li SJ, Su KB, Wu LS. Purple urine bag syndrome: A case report and review of the literature. J Intern Med Taiwan 2002;13:209-12.  Back to cited text no. 3
    
4.
Dealler SF, Hawkey PM, Millar MR. Enzymatic degradation of urinary indoxyl sulfate by Providencia stuartii and Klebsiella pneumonia causes purple urine bag syndrome. J Clin Microbiol 1988:26:2152-6.  Back to cited text no. 4
    
5.
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;24:534-6.  Back to cited text no. 5
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6.
Dharmshaktu GS, Pangtey T. Purple urine bag as indicator of multidrug-resistant vulvar abscess: Lessons for primary caregivers. J Family Med Orim Care.2018;7:484-5.  Back to cited text no. 6
    


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