Carolinas Research Day 2021

Clinical Case-Based Studies

09 Purple Urine Bag Syndrome: An Unusual Cause of Fever in a Patient with Bilateral Nephrostomy

Hunter Harrison, OMS-III and Chad Millwood, MD

Edward Via College of Osteopathic Medicine-Carolinas

Abstract: Purple urine bag syndrome (PUBS) is a rare but distinctive cause of a discolored urinary bag, typically arising in the context of predisposing factors that influence tryptophan metabolism. We report the case of a 78-year-old male with a history of cystoprostatectomy and bilateral nephrostomy tube placement, presenting with a 3-day history of subjective fever. Purple discoloration within his urinary bag was observed on physical exam, prompting urinalysis and culture that revealed evidence of a urinary tract infection (UTI). Although our patient was successfully treated with a short

course of ciprofloxacin, there have been reports of poor outcomes in patients with undetected (and thus unaddressed) PUBS. Notably, there are very few cases of PUBS reported in patients with nephrostomy; our case highlights the fact that PUBS can serve as an important clinical clue in these patients, who may lack the typical symptoms of UTI (e.g., dysuria). Recognition of this unusual entity allows timely intervention, preventing progression to far more concerning conditions such as Fournier gangrene, sepsis, or death.

54