Purple urine bag syndrome: A case report and review of literature
An 83-year-old bed bound female, with a history of dementia who had an indwelling urinary catheter in place for last 3 months, presented to us in the outpatients department with the complaints of nausea, vomiting, decreased oral intake, chronic constipation, and purplish discoloration of the urine bag and tubing. She had been having these complaints on and off (three times over a period of 1 month) before coming to us and every time she was treated empirically with oral antibiotics (records not available) for suspected UTI. Her urinary catheter and bag were changed each time she would get purple discoloration and her symptoms would get better. When she presented to our facility, she was hemodynamically stable and was afebrile. Physical examination was unremarkable except for mild dehydration. She was noticed to have purple colored urine in the urine bag, along with purplish discoloration of the tubing and the bag []. Investigations revealed a hemoglobin of 12 g/dl and total leukocyte count of 11 × 109. Her blood urea was 40 mg/dl, serum creatinine 0.9 mg/dL, serum sodium 135 mEq/L, potassium 4.2 mEq/L, chloride 110 mEq/L, and bicarbonate was 20 mEq/L. Her urine dipstick showed a pH of 8.0, specific gravity 1.020, and it was positive for nitrite. Urine microscopy revealed 4-6 leucocytes, 3-5 red blood cells, and triple phosphate crystals. Urine culture was sent and she was started on oral cefixime (third generation cephalosporin). Lactulose was also prescribed for relieving constipation. The patient was seen after 3 days, and reported resolution of symptoms and disappearance of purple color. Urine culture grew greater than 105 colony forming units of Escherichia coli sensitive to cefixime. She completed a 10 days course of cefixime and has been symptom free till the last follow-up visit.