An Under-recognised Rare Purple Urine Bag Syndrome

Chai, Chau Chung and Chow, Kok Cheow (2023) An Under-recognised Rare Purple Urine Bag Syndrome. American Journal of Physical Medicine and Rehabilitation, 102 (4suppl). p. 171. ISSN 0894-9115

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Abstract

CASE DIAGNOSIS: Purple Urine Bag Syndrome (PUBS) CASE DESCRIPTION: We report an under- recognised PUBS in a 69-year-old male nursing home resident who has underlying brainstem cavernoma and PUBS risk factors of chronic urinary catheterisation and constipation. During his hospital follow-up, he raised concern of mental disturbance by his purplish urinary bag appearance which was suggestive of PUBS. Prior to hospital visit, he had sought treatment from a clinic whereby he was misdiagnosed as due to food dye. He had developed suprapubic pain and low-grade fever during hospital visit and treated as symptomatic PUBS. His urinary catheter and bag were changed. He was empirically prescribed on oral co-amoxiclav antibiotic for one week as per local guideline and stool softener to aid bowel evacuation. Urinalysis showed urinary tract infection (UTI) picture with urine culture grew Proteus mirabilis which was sensitive to oral co-amoxiclav. His symptomatic PUBS resolved after two days of antibiotic initiation. DISCUSSION: PUBS is a rare manifestation of UTI whereby urinary bag and catheter turn purplish which can be mentally disturbing. PUBS is a spot diagnosis to a keen-eye clinician, but PUBS may be overlooked by unaware clinician. Often described as benign, PUBS can however cause life-threatening complications like urosepsis. PUBS has been reported to occur predominantly among chronic disabling people in nursing or rehabilitation facilities. PUBS risk factors include female gender, constipation, and chronic indwelling urinary catheterisation. Asymptomatic PUBS management should aim at mitigating risk factors; regularly change of urinary bag and avoid constipation. Treatment of symptomatic PUBS involves appropriate antibiotic. Reassurance of PUBS natural course can ease patient’s mental distress. CONCLUSION: As the world is rapidly aging, nursing and rehabilitation facilities will proliferate with increasing population with chronic catheterisation and at risk for PUBS. Thus, this case report aims to increase awareness of PUBS for optimal prevention and management.

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