Purple urine bag syndrome is an uncommon symptom and is often thought to be associated with urinary tract infections. Although similar symptoms have been reported many times, there are still misdiagnoses and mismanagement, and patients are greatly affected physically and mentally.
In August 2021, physicians at the Yarmouk University School of Medicine in Jordan discovered that an 80-year-old woman with type 2 diabetes, chronic kidney disease (ckd) stage 5, hypertension and ischemic stroke developed purple bag syndrome. So, what does it mean for patients with ckd to develop purple urine bag syndrome? Is the situation serious? What kind of treatment is needed?
Case profile
The patient is 80 years of age in women with type 2 diabetes mellitus, chronic kidney disease (ckd) stage 5, hypertension and ischemic stroke. She relies on a wheelchair to move due to dislocation and weakness in her lower extremities. Due to incontinence, she underwent indwelling urinary catheter therapy and, notably, she had a history of recurrent urinary tract infections. One month before the visit, a final catheter replacement was performed. At the time of treatment, the medical staff found that the urine in his urine bag was purple in color.
Patient complaints: constipation but denial of fever, chills, or abdominal pain. The remaining symptoms are not significantly reviewed.
Patient history: amlodipine 5 mg / day, bisoprolol 5 mg / d, furosemide 40 mg / day, sodium bicarbonate 1000 mg / day, ferrous gluconate 300 mg / day, insulin 2 times / day.
Patients have concomitant lower extremity depression edema, and the rest of the cardiopulmonary examination is normal.
Two days before the visit, doctors at other medical institutions considered the above symptoms to be hematuria, but doctors at the Yarmouk University School of Medicine in Jordan believed that this was a misdiagnosis.
After the catheter is changed, the patient begins to take antibiotics and laxatives, and the doctor sends a urine sample for urinalysis and urine culture. The results showed that the urine ph was 8.0, the glucose was negative, the white blood cell count was 8-10/hpf, and the red blood cell count was 3-5 hpf. Urine cultures show large growths of Proteus mirabilis and sensitivity to amoxicillin/clavulanate, ceftriaxone, and ciprofloxacin.
After retrieving her medical records, it was found that the patient had undergone a urine culture 6 weeks before the visit and found that she had E. coli. Blood creatinine was 328 μmol/l (normal range 40-80), urea was 30.2 mmol/l (normal 2.8-8.9), and phosphate was 1.68 mmol/l (normal 0.84-1.45), all three of the above indicators were elevated, while the other indicators were in the normal range.
So the doctor asked the patient to take ciprofloxacin orally (500 mg/tablet, one tablet daily for 5 days). After a week, the patient's urine returns to normal, and doctors recommend changing the catheter regularly every month, which can reduce the risk of urinary tract infection.
Discussion
In 1798, Barlow et al. first reported purple urine bag syndrome. These disorders are rare, often associated with urinary tract infections and urinary catheters, and are often misdiagnosed as hematuria initially, so treatment is the wrong approach.
Patients with ckd are not at high risk for purple urine bag syndrome, but patients with advanced ckd (renal failure) are more likely to develop purple urine bag syndrome than the general population. The cause is that the patient's uremia toxin accumulates in the blood, which may lead to an increase in indophenol sulfate in the urine. Phosphatase and sulfate enzymes produced by some bacteria convert indophenol sulfates into indole groups. Indole group oxides are red and blue, and as such, tend to appear purple.
In addition, patients with constipation, increased tryptophan in the diet, increased urine pH, and catheter indwelling are more likely to develop purple urine bag syndrome.
Physicians at the Yermouk University School of Medicine suggest that changes in urine color can be caused by a variety of causes, such as toxic substances, food colorings, drugs, urinary tract infections, urinary stones, hematuria, hemoglobinuria, and porphyria.
Summary
Overall, purple urine bag syndrome is a rare condition that can be easily misdiagnosed. This can lead to incorrect administration and unnecessary checks. Physicians need to be aware of this phenomenon in order to provide appropriate care to their patients.
bibliography:
1.sarairehm, gharaibeh s, araydah m, et al. violet discoloration of urine: a case reportand a literature review. ann med surg (lond). 2021 jul 16;68:102570. ecollection2021 aug.