Purple urine bag syndrome: An unusual presentation of urinary tract infection: A case series and literature review

Abstract

RATIONALE: Purple urine bag syndrome (PUBS) is a rare but visually alarming condition associated with urinary tract infections (UTIs), typically occurring in debilitated elderly patients with long-term indwelling catheters. Awareness of PUBS is essential, as it can serve as an indicator of underlying infection. PATIENT CONCERNS: Two elderly male patients presented with striking purple discoloration of their urinary catheter bags. Caregivers expressed concern, although both patients denied fever, dysuria, or suprapubic pain. DIAGNOSES: PUBS secondary to UTI was diagnosed. Case 1 involved mixed bacterial growth, with risk factors including diabetes mellitus, benign prostatic hyperplasia, immobility, and prolonged catheterization. Case 2 had Candida tropicalis infection, with predisposing factors of stroke-related immobility, constipation, and chronic catheterization. INTERVENTIONS: Both patients underwent a Foley catheter and urine bag replacement. Case 1 received empirical oral ciprofloxacin, while case 2 required admission, intravenous antifungal therapy, and supportive hydration. OUTCOMES: Purple discoloration resolved after catheter replacement. Both patients achieved favorable outcomes without recurrence. LESSONS: While PUBS is typically benign, it reflects underlying UTIs and requires prompt intervention. Early recognition, catheter management, and appropriate antimicrobial therapy are key to preventing complications. Clinician awareness is vital to avoid misdiagnosis and unnecessary anxiety.