Clinical Images  |   October 2018
Purple Urine Bag Syndrome
Author Notes
  • From US Acute Care Solutions, LLC, in Columbus, Ohio (Dr Casey), and Cleveland Clinic Akron General in Ohio (Dr Francescon). 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to: John Francescon, DO, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307-2432. Email: jfrancescon22@gmail.com
     
Article Information
Emergency Medicine / Imaging / Pain Management/Palliative Care / Urological Disorders / Clinical Images
Clinical Images   |   October 2018
Purple Urine Bag Syndrome
The Journal of the American Osteopathic Association, October 2018, Vol. 118, 689. doi:10.7556/jaoa.2018.151
The Journal of the American Osteopathic Association, October 2018, Vol. 118, 689. doi:10.7556/jaoa.2018.151
A patient presented to the emergency department with 2 weeks of dark urine, nausea, vomiting, and pain around her urostomy site. She was admitted for suspected bacterial sepsis, and subsequent urine cultures grew Providencia rettgeri, a species commonly associated with purple urine bag syndrome, which this patient had (image).1 The patient was discharged 3 days later after antibiotic administration and resolution of symptoms. 
Purple urine bag syndrome is a phenomenon in which the urine bag and tubing in patients with long-term catheterization turn blue or purple secondary to a urinary tract infection. The pathogenesis of purple urine bag syndrome is related to the colonization of sulfatase- and phosphatase-producing bacteria that metabolize tryptophan into indigo and indirubin, which then accumulate and give urine the purple color.2 

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