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:
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:
The Journal of the American Osteopathic Association, October 2018, Vol. 118, 689. doi:
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 
Lin CH, Huang HT, Chien CC, Tzeng DS, Lung FW. Purple urine bag syndrome in nursing homes: ten elderly case reports and a literature review. Clin Interv Aging. 2008;3(4):729-734. [PubMed]
Hadano Y, Shimizu T, Takada S, Inoue T, Sorano S. An update on purple urine bag syndrome. Int J Gen Med. 2012;5:707-710. doi: 10.2147/IJGM.S35320 [CrossRef] [PubMed]