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Abstract: TH-PO768

Purple Urine Bag Syndrome in an Elderly Female With Constipation and Urinary Tract Infection

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology


  • Bauman, Allison Ann, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, United States
  • Kannan, Lakshmi, Pikeville Medical Center, Pikeville, Kentucky, United States
  • Nelson, Brandon, Pikeville Medical Center, Pikeville, Kentucky, United States

Purple Urine Bag Syndrome (PUBS) is an uncommon event that causes the urine of those affected to turn various shades of purple. Risk factors for PUBS include female gender, chronic catheterization, advanced age, constipation, chronic kidney disease (CKD), and urinary tract infections (UTI’s).(1) The purple urine is caused by elevated levels of the pigments indigo and indirubin.(1) In this article, we present a case in which an elderly female with a history of long-dwelling catheterization and CKD develops purple urine in the setting of a UTI and constipation.

Case Description

A 76-year-old female with a history of stage III CKD who was chronically catheterized presented to the hospital with shortness of breath from CHF exacerbation. After experiencing constipation for four days, her urine was noted to be purple (Figure 1). Urinalysis showed alkaline urine (pH of 8.5) with a large amount of blood, nitrites, leukocyte esterase, and proteins, and urine culture revealed more than 100,000 CFU/mL of Proteus mirabilis. In the setting of her discolored urine, these findings are consistent with PUBS. She was started on empiric ceftriaxone for UTI and miralax/senna twice daily for constipation. Her constipation resolved, and a 5-day course of antibiotics was completed.


PUBS tends to occur primarily in constipated women with sulphatase/phosphatase-producing bacteria in their urinary tracts.(2) These bacteria convert indoxyl sulfate into indoxyl which, when metabolized in an alkaline environment, gives rise to indirubin and indigo.(1) PUBS is generally considered benign; however, if the infection underlying PUBS becomes too severe, serious disease (i.e. Fournier’s gangrene) can result.(3)

Figure 1. Dark purple urine in a Foley catheter bag. Patient's urine turned dark purple after four days of constipation.