Purple Urine Bag Syndrome: Uncommon Clinical Entity Associated with Common Infection, Case Report

Abstract

 Purple urine bag syndrome (PUBS) is a rare medical syndrome where purple discoloration of urine occurs predominantly in chronically constipated bedridden elderly women, chronically catheterized and associated with   urinary tract infections (UTIs). The etiology is related to UTIs with specific bacteria that produce sulphatase and phosphatase enzymes which lead tryptophan metabolism to produce two pigments: Indigo (blue) and indirubin (red), mixtures of which become purple in color. Several risk factors are associated with PUBS; including female gender, increased dietary tryptophan, alkaline urine, constipation, catheterization, high urinary bacterial load, renal failure and use of polyvinyl chloride plastic catheters. Herein, I present this rare benign interesting condition on a 78 years old lady with purple discoloration of her urine bag due to urinary tract infection caused by Escherichia coli that was successfully treated by culture guided antibiotic (Ciprofloxacin). The purple urine disappeared after antibiotic therapy and change of the urine catheter and bag.