P1298 - Purple Rain in the Catheter: A Colorful Case Report of Purple Urine Bag Syndrome

Fatima Ahson, MD, Oscar Hernandez, MD
Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL

Introduction: Purple Urine Bag Syndrome (PUBS) is a rare condition characterized by the development of purple-colored urine in individuals with specific predisposing factors. It primarily affects those with a history of constipation or long-term indwelling foley catheters. Dysregulated tryptophan metabolism in the digestive tract due to bacterial overgrowth is believed to be the underlying pathophysiology.

Case Description/Methods: We present the case of a 58-year-old female who presented with dysuria and purple-colored urine. The patient had a foley catheter inserted for managing Neurogenic Bladder. Empirical treatment with Ceftriaxone was initiated due to urinary symptoms. Urinalysis confirmed a urinary tract infection, with subsequent cultures identifying Proteus species. The patient was transitioned to oral antimicrobials and discharged.

Discussion: Patients with chronic constipation and indwelling foley catheters often experience dysregulated gut microbiome, leading to bacterial overgrowth in the gastrointestinal tract. This overgrowth alters the metabolism of tryptophan, resulting in the production of indole. Further metabolism in the liver converts indole into indigo and indirubin, causing the urine to turn purple. Gram-negative organisms, particularly E. Coli, Proteus mirabilis, Proteus vulgaris, and Pseudomonas aeruginosa, are common culprits of PUBS in patients with long-term foley catheters. Although PUBS is generally a benign condition, it is crucial to educate both patients and healthcare providers about its occurrence. This awareness will not only alleviate patient concerns but also enable healthcare professionals to educate patients about proper catheter care and hygiene.


Disclosures:


Fatima Ahson, MD, Oscar Hernandez, MD. P1298 - Purple Rain in the Catheter: A Colorful Case Report of Purple Urine Bag Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.