Purple Urine Bag Syndrome is a rare condition characterized by purple discoloration of the urinary drainage bag. It is typically seen in elderly patients with chronic indwelling urinary catheterization, and is associated with urinary tract infections with high bacterial load, female gender, severe disability, constipation, and alkaline urine. This phenomenon occurs when tryptophan metabolites in the urine are broken down by bacteria containing indoxyl sulphatase and phosphatase enzymes. This results in the production of indigo and indirubin, which combine to give a purple appearance. This article presents a 78-year-old male with chronic urinary retention requiring intermittent Foley catheterization for the last three months, who was brought to the Emergency Department for altered mental status and purple urinary bag discoloration. Urinalysis was suggestive of urinary tract infection, and Vancomycin, Aztreonam, and Levaquin were initiated. After urine culture and antibiotic susceptibility testing, only Levaquin was continued, and subsequently the patient’s symptoms resolved. This case serves to educate healthcare professionals in West Virginia about this condition, which we hope will benefit in its diagnosis, management, and targeted prevention, especially in light of an aging population.
Conflict(s) of Interest
References with DOI
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. https://doi.org/10.4061/2011/419213
2. Arnold WN. King George III's urine and indigo blue. Lancet. 1996;347(9018):1811-3. https://doi.org/10.1016/s0140-6736(96)91622-0
3. Barlow GB, Dickson JAS. Purple urine bags. The Lancet. 311(8057):220-1. https://doi.org/10.1016/s0140-6736(78)90667-0
4. Su YJ, Lai YC, Chang WH. Purple urine bag syndrome in a dead-on-arrival patient: case report and articles reviews. The American journal of emergency medicine. 2007;25(7):861.e5-6. https://doi.org/10.1016/j.ajem.2007.02.015
5. Su FH, Chung SY, Chen MH, Sheng ML, Chen CH, Chen YJ, et al. Case analysis of purple urine-bag syndrome at a long-term care service in a community hospital. Chang Gung medical journal. 2005;28(9):636-42. https://doi.org/10.1016/j.ajem.2007.02.015
6. Pillai BP, Chong VH, Yong AM. Purple urine bag syndrome. Singapore Med J. 2009;50(5):e193-4.
7. Harun NS, Nainar SK, Chong VH. Purple urine bag syndrome: a rare and interesting phenomenon. South Med J. 2007;100(10):1048-50. https://doi.org/10.1097/smj.0b013e318151fba4
8. Aycock RD, Kass DA. Abnormal urine color. South Med J. 2012;105(1):43-7. https://doi.org/10.1097/smj.0b013e31823c413e
9. Tasi YM, Huang MS, Yang CJ, Yeh SM, Liu CC. Purple urine bag syndrome, not always a benign process. The American journal of emergency medicine. 2009;27(7):895-7. https://doi.org/10.1016/j.ajem.2009.01.030
10. West Virginia Center on Budget and Policy. The State of Older Adults in West Virginia: Economic Security and the Over 65 Population. West Virginia: West Virginia Center on Budget and Policy; 2012.
Gebrmichael, Teshome; Feleke, Fikirte; Ahmed, Waseem; Urella, Madhulika; and Teka, Samson
"Purple Urine Bag Syndrome: An Educational Case of a Colorful Condition in the Chronically Catheterized,"
Marshall Journal of Medicine:
3, Article 6.
Available at: https://mds.marshall.edu/mjm/vol3/iss3/6