US doctors described a rare case of purple urine bag syndrome (PUBS) in the February issue of the journal Oxford Medical Case Reports. A 76-year-old woman, hospitalized with shortness of breath, presented purple urine following four days of hospitalization.
The patient, with a history of heart failure, chronic kidney disease and bladder cancer, had been admitted to treat an acute heart injury found on imaging tests following complaining of shortness of breath.
While she was hospitalized, doctors at the Department of Nephrology at the Pikeville Medical Center, in the state of Kentucky, chose to insert a probe into the American’s urethra to administer a diuretic medication.
After four days, the team noticed that the urine trapped in the catheter bag had changed color, indicating a case of purple urine bag syndrome (PUBS).
Bacterial infection
Tests showed that her urine was extremely alkaline, with a pH of 8.5, with high amounts of blood, nitrites, leukocyte esterase and protein, an indication that her kidneys were not working properly.
The condition is a rare side effect – it affects between 8.3% and 42.1% of patients connected to long-term catheters – and indicates a bacterial urinary tract infection. The purple color is the result of a chemical reaction in the patient’s liver, which produces pigments in blue and red tones (indigo and indirubin).
“The urine that enters the catheter is normal in color, but the purple color soon appears due to the development of indigo and indirubin by the presence of urinary bacteria. These pigments interact with the plastic material of the catheter and tube pocket and produce the purple color,” explained the authors of the article.
The most important risk factors include long-term catheterization, being female, chronic constipation, advanced age, and being bedridden.
Doctors state that although it is benign in nature and only changes in urine color from yellow to purple occur, PUBS results in increased anxiety in patients and family members who are alarmed by the color of the urine bag.
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