SHM Converge Scientific Abstract ePoster Gallery-Purple Urine Bag Syndrome: A Colorful Clue to an Underlying Infection

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Purple Urine Bag Syndrome (PUBS) is a rare but striking sign of urinary tract infection, usually seen in chronically catheterized patients and associated with alkaline urine. It results from bacterial metabolism of urinary indoxyl sulfate, producing purple pigments in catheter or nephrostomy tubing and bags. Risk factors include long-term catheterization, female sex, older age, constipation, high tryptophan intake, renal failure, and urinary stasis. Common causative organisms include Proteus, Providencia, Klebsiella, E. coli, Enterococcus, and Morganella.<br /><br />The case described a 46-year-old man with paraplegia, neurogenic bladder, bilateral nephrostomy tubes, chronic kidney disease, and recurrent UTIs who presented with decreased drainage from one nephrostomy tube and purple urine in the other. He was hypotensive with leukocytosis, severe azotemia, and imaging evidence of bilateral xanthogranulomatous pyelonephritis and a displaced tube. Urine culture grew ESBL Proteus mirabilis, and blood cultures showed polymicrobial bacteremia, including Bacteroides fragilis, Globicetella sanguinis, and Enterococcus species. He required broad-spectrum antibiotics, nephrostomy tube exchange, ICU care, and temporary hemodialysis for worsening acute kidney injury and encephalopathy.<br /><br />PUBS is often benign in appearance but can indicate serious infection, including urosepsis or bacteremia, especially in patients with indwelling urinary devices. Management focuses on prompt recognition, urine and blood cultures, imaging when indicated, targeted antibiotic therapy, and restoration of urinary drainage through catheter or tube replacement. This case highlights that PUBS can occur even in younger, nontraditional patients and may involve the upper urinary tract, making early evaluation and treatment essential.

Asset Subtitle

William C. Lippert

Meta Tag

Author List John Slovensky, Marc Perlman, Phillip Ball, Taylor C. Ellis, William C. Lippert

Category Clinical Vignettes

Concept Purple Urine Bag Syndrome

Concept Sepsis

Concept Urinary Tract Infection

Concept Bacteremia

Concept Alkaline Urine

Distinguished Non-Finalist

Presenter Organization Wake Forest University School of Medicine

Presenting Author William C. Lippert

Track Adult

Keywords

Purple Urine Bag Syndrome

PUBS

urinary tract infection

nephrostomy tubes

catheter-associated infection

Proteus mirabilis

polymicrobial bacteremia

chronic kidney disease

urosepsis

urinary drainage obstruction

Purple Urine Bag Syndrome

Sepsis

Urinary Tract Infection

Bacteremia

Alkaline Urine