Purple Urine Bag Syndrome in a Critically Ill Patient: Case Report
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MEDICINE
Purple Urine Bag Syndrome in a Critically Ill Patient: Case Report Heidi Angela Fernandez 1
&
Martín Lescano Ruiz 1,2 & Stephanie González Jara 3
Accepted: 10 September 2020 # Springer Nature Switzerland AG 2020
Abstract Purple urine bag syndrome (PUBS) is a rare manifestation characterized by purple discoloration of the urine drainage system. It may appear as a disconcerting finding for patients and healthcare workers not aware of this condition. It’s mostly seen in patients with long-term urine catheterization and a coexisting urinary tract infection (UTI); however, this is not always the case. We describe the case of a 43-year-old patient with cervical cancer and end-stage renal disease who presented to the emergency room with fever and urinary retention which required catheterization. Three hours later, purple urine was noted in the bag. She was diagnosed with bacteremia and a urinary tract infection which were treated with intravenous antibiotics, eventually presenting an unfavorable clinical evolution. Although usually considered benign, it does not always run a harmless course. It’s important to assess this finding on a patient-specific basis to uncover a possible underlying UTI, considering that some may not be able to adequately communicate symptoms, as is the case of the critically ill or patients with communication difficulties. This report contributes to raising awareness and a better comprehension of this unusual entity. Keywords Case report . End stage renal disease . Purple urine bag syndrome . Urinary catheterization . Urinary tract infection
Introduction Macroscopic examination is an important aspect of urinalysis, especially in patients with urinary catheterization [1]. Possible alterations may include urine discoloration due to endogenous or exogenous pigments [2]. Color changes could provide useful information about possible underlying medical conditions. One such case is that of purple urine bag syndrome (PUBS), an infrequent but striking finding. PUBS is a condition characterized by purple discoloration in the urine drainage system caused by a chemical reaction involving tryptophan metabolism and facilitated by certain bacteria in patients with urinary catheterization. Predisposing factors include repeated urinary tract infections, comorbid patients, chronic constipation, This article is part of the Topical Collection on Medicine * Heidi Angela Fernandez [email protected] 1
Department of Internal Medicine, Hospital Eugenio Espejo, Calle Gran Colombia, Quito, Pichincha, Ecuador
2
Postgrado de Medicina Interna. Pontificia Universidad Católica del Ecuador, 12 de Octubre Ave, 1076 Quito, Pichincha, Ecuador
3
Universidad Estatal de Milagro, Cdla. Universitaria Km. 1.5 vía Km. 26, Milagro, Guayas, Ecuador
female gender, advanced age, renal failure, the use of a polyvinylchloride (PVC) catheter, long-term catheterization, diets rich in tryptophan, and alkaline urine [3]. We present a case of PUBS with rapid urine discoloration after urinary catheterization in a patient with cer
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