Infección urinaria de presentación atípica: caso clínico y revisión de literatura

Introducción: el síndrome de orina púrpura es una presentación clínica poco frecuente en el ámbito de urgencias, caracterizado por coloración anormal de la orina secundaria a una reacción química de algunos patógenos que producen infección de vías urinarias, siendo más frecuente en pacientes con múltiples comorbilidades y diferentes factores de riesgo. Objetivo: el objetivo de este manuscrito es presentar el caso de un paciente con síntomas atípicos de infección de vías urinarias. Presentación del caso: varón de 88 años de edad, con antecedente de diabetes mellitus no insulino-requiriente, con hiperplasia prostática benigna que ingresó al servicio de urgencias por síntomas irritativos urinarios asociados a uso de sonda vesical, con orina de coloración violeta en bolsa recolectora. El urocultivo reportó la presencia de Proteus vulgaris multisensible, por lo que se decidió dar manejo con cefepima de 1 gr cada ocho horas, con lo cual se obtuvo una adecuada evolución clínica. Discusión y conclusión: el síndrome de la bolsa de orina púrpura es una presentación clínica atípica, pero muy llamativa de la infección urinaria. Esta se genera como resultado de la conversión del triptófano en la dieta en indoxil sulfato que, una vez se elimina por la orina, se transforma en índigo (color violeta) e indirrubina (color rojo), dando este aspecto clínico.

Background: Purple urine syndrome is a rare clinical presentation in the emergency room, characterized by abnormal colouration of the urine secondary to a chemical reaction of some pathogens that cause urinary tract infection, being more frequent in patients with multiple comorbidities and different risk factor's. Purpose: The objective of the article is present the case of a patient with atypical symptoms of urinary tract infection. Clinical case: An 88-year-old male, with a history of non-insulin diabetes mellitus, benign prostatic hyperplasia, who was admitted to the emergency room due to irritative urinary symptoms associated with the use of a urinary catheter, with purple urine in a collection bag. Urine culture reported the presence of multisensitive Proteus vulgaris, for which it was decided to give treatment with Cefepime 1 g every 8 hours, with which it was obtained with adequate clinical evolution. Conclusions: Purple urine bag syndrome is an atypical but very striking clinical presentation of urinary tract infection. This is generated as a result of the conversion of tryptophan in the diet into indoxyl sulfate, which, once it is eliminated in the urine, transforms into indigo (purple color) and indirubin (red color), giving this clinical appearance.

Síndrome de la Bolsa de Orina Púrpura. Reporte de caso y revisión de la literatura / Purple Urine Bag Syndrome. Case report and literature review

RESUMEN El síndrome de la bolsa de orina púrpura es una entidad poco frecuente, con una prevalencia hasta de un 8% en pacientes con catéteres permanentes crónicos por más de 2 años. Esta condición se presenta en portadores de sonda vesical, siendo su principal signo clínico la aparición de orina de color púrpura, debida a la producción de sulfatasas y fosfatasas por enterobacterias. Se presenta un caso de una mujer de 63 años con diagnóstico de vejiga neurogénica, antecedente de enfermedad cerebrovascular y secuelas motoras debidas a neoplasia cerebral, quien consultó por presentar el color característico, con síntomas de infección del tracto urinario inferior. Se trató con nitrofurantoína y tuvo normalización del color urinario al quinto día de tratamiento. El diagnóstico de este síndrome implica un reto para el médico, y deben detectarse los factores de riesgo para proveer un adecuado manejo antimicrobiano y evitar el uso de recursos diagnósticos innecesarios. MÉD.UIS.2021;34(2): 83-8.

ABSTRACT Purple urine bag syndrome is a rare entity, with a prevalence of up to 8% in patients with chronic indwelling catheters for more than 2 years. This condition occurs in bladder catheter carriers, being the main clinical sign the appearance of purple urine, due to the production of sulphatases and phosphatases by Enterobacteriaceae. We present a clinical case of a 63-year-old woman with a diagnosis of neurogenic bladder and a history of cerebrovascular disease and motor sequelae due to brain neoplasia, who consulted for presenting that urine characteristic color, with symptoms of lower urinary tract infection. She was treated with nitrofurantoin and she had normalization of urinary color on the fifth day of treatment. The diagnosis of this syndrome implies a challenge for the physician, and risk factors must be detected to provide adequate antimicrobial management and avoid the use of unnecessary diagnostic resources. MÉD.UIS.2021;34(2): 83-8.

Purple Urine Bag Syndrome in Two Palliative Care Patients

@#Purple urine bag syndrome (PUBS) is a rare manifestation of urinary tract infections resulting in bright purple discolouration of the urine catheter bag and tubing. The phenomenon is common in elderly woman with constipation and urinary tract infections associated with long term indwelling catheter (IDC) use. We present two cases of PUBS witnessed in the emergency department.

Purple urine bag syndrome: Case report from a nursing home resident with a false alarm of urosepsis

Purple urine bag syndrome (PUBS), as the name implies produces purplish discoloration of the urine. It is commonly observed among elderly women with constipation, and individuals with long term catheter in the setting of urinary tract infection (UTI). From the literature research, there were no publications on PUBS in Malaysia; however we believe that it is underreported. We present a unique case of this rare condition occurring in a 68-year-old man, a nursing home resident on long term urinary catheter. The urine cleared after hydration, antibiotic therapy and replacement of the catheter.

Síndrome de la bolsa de orina púrpura: un fenómeno inusual y muy llamativo / Purple urine bag syndrome: Report of one case

Purple urine bag syndrome is an uncommon but particularly striking phenomenon observed in people with urinary catheters and co-existent urinary tract infections. A chemical reaction between plastic and certain bacterial enzymes results in an intense purple urine color. We report a 72 year-old male with a cystostomy. A purple coloration of his urinary drainage bag and tubing was noted in the context of a urinary tract infection caused by Citrobacter freundii.

Purple urine bag syndrome- changing hue.

Purple Urine Bag Syndrome (PUBS) is a unique disease entity characterised by purple discoloration of urine secondary to recurrent urinary tract infections with indigo and indirubin producing bacteria and is predominantly seen in constipated, chronically debilitated and catheterised women with alkaline urine. This syndrome indicates underlying recurrent urinary tract infections (UTIs) associated with higher incidence of mortality and morbidity than urinary tract infection alone without this occurrence. This article is about an elderly hypothyroid woman with PUBS and reviews the need to be aware of this entity.

Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare condition, in which the patient has a purple-colored urine tubes or bags following urinary catheterization for hours to months. It is usually associated with elderly females, prolonged urinary catheterization, some bacterial infections that produce sulphatase/phosphatase, chronic debilitated state, and chronic constipation. We present a case report of this rare phenomenon occurring in a 73-year-old woman.

Síndrome de la bolsa de orina púrpura / Purple urine bag syndrome

Se presenta el caso de un paciente masculino de 62 años remitido por oncología para estudio por presentar orina de color morado. Desde hace tres meses tiene sonda vesical permanente por retención urinaria posterior a una resección quirúrgica de una metástasis cerebral por tumor primario a nivel pulmonar, tiene pendiente radioterapia holoencefálica y posterior quimioterapia sistémica. La única medicación que tomaba de manera intermitente era omeprazol, refería además anorexia y náuseas. La bolsa urinaria contenía orina de color morado y a la extracción aparecía turbia. El análisis de la orina fue compatible con infección urinaria. El color de la orina en la bolsa fue motivo de una interesante discusión científica. Se discuten los mecanismos a través de los cuales la orina toma dicho color (Acta Med Colomb 2011; 36: 38-40).

The case is presented of a 62-year-old male patient who was referred by the Oncology Department for evaluation of purple-colored urine. Over the past three months the patient has had an indwelling catheter because of urinary retention after surgical resection of a brain metastasis of a lung tumor. The patient is to be treated with holoencephalic radiotherapy and afterwards with systemic chemotherapy. The only current medication was omeprazole, which he took intermittently. He also complained of anorexia and nausea. The urinary bag contained purple-colored urine, which appeared turbid upon extraction. Urinalysis was consistent with urinary tract infection. The color of the urine gave rise to an interesting scientific discussion. The mechanisms are discussed through which urine takes a purple color (Med Colomb 2011; 36: 38-40).

Purple Urine Bag Syndrome / 대한비뇨기과학회지

Purple urine bag syndrome (PUBS) is a rare phenomenon where the urinary catheter and bag turns purple following catheterization. The colors are formed from the substrate indoxyl sulfate (indican). PUBS is associated with urinary tract infections induced by the reaction of some species of bacteria with indoxyl sulfatase. We report here in a case of purple urine bag syndrome.

A drowsy patient with a positive purple urine test.

We report a pitfall in the investigation of amphetamine poisoning by urine test. A 21-year-old female who came to hospital with drowsiness and was reported to have positive purple urine test. This false positive urine test occurred as a result of drugs and substances of the same structure. Specific investigations were further recommended in order to detect the use of the amphetamines and allow appropriate treatment.