Contributions
Abstract: PB2045
Type: Publication Only
Background
Purple urine bag syndrome (PUBS) is a rare disorder characterized by purple discoloration of urine inside the urine collection bag and tube.It's usually seen in elderly women with a history of chronic or acute renal failure and constipation during longterm urinary catheterisation.Recognition of this entity is important to minimize concern and distress for patients and their relatives and also to avoid overmanagement.
Aims
CASE 1. An 86 year old woman was hospitalized because of anorexia,fever and asthenia.Her past medical history included arterial hypertension and chronic constipation.Basic investigations were done Hb 91 g/L, platelet count 18x109/L and leucocytes 41.6 K/mcL. The bone marrow smear was compatible with Acute Myelomonocytic Leukaemia (AML) with negative cytogenetic and molecular biology. Due to the elderly conditions of the patient,palliative support treatment was decided.After 72 hours she presented lower abdominal pain with acute urinary retention and a urinary catheter was introduced.During the hospitalization,a purple discoloration of the urine bag and tube was noted.Urine examination showed urine leucocytes without RBC’s with multi sensitive E. Coli on the urine culture.She was started on parenteral Ciprofloxacin and the catheter was changed,the purple urine returned to its normal colour but she died 48 hours later. CASE 2.An 88 year old woman was admitted to the Palliative Care Unit because of fever and dysuria in the context of neutropenia grade IV and severe constipation during the preceding days.Her past medical history included AML with normal karyotype and high rated FLT3-ITD diagnosed 6 months apreviously.She was receiving palliative support due to her age.On admission,she was found to have bleeding diathesis and acute urinary retention.Pan-sensitive E.coli was isolated from blood and urine cultures.She was treated with intravenous Ciprofloxacin, urine catheterisation and laxatives.48 hours later, she developed severe sepsis with hemodynamic instability and refractory hypotension.The urine in the bag was strikingly purple in colour.Because of the refractory sepsis condition and a terminal AML diagnosis,finally died 72 hrs after admission.
Methods
PUBS is a rare phenomenon where urine in catheter bags and tubing turns purple. The prevalence is unknown, range estimate between 8.3% and 42.1%.
Results
PUBS occurs when the pigments indigo and indirubin,products of bacterial sulphatase and phosphatase mediated tryptophan metabolism,accumulate in the urine and cross react with the PVC of catheter tubing to produce a purple hue.These bacteria include Providencia spp,Citrobacter spp,Klebsiella pneumoniae,Proteus spp,Escherichia coli,Enterococcus spp,Morganella morganii,Pseudomonas aeruginosa and B Streptococci.The principal PUBS risk factors include elderly patients,renal disease,chronic catheterisation,dehydratation,severe constipation,increased dietary thryptophan,high urinary bacterial load and urine alkalinity.There are several causes that change the urine colour:food dyes,drugs,haematuria,myoglobinuria,nephrolithiasis and poisons so it’s important to consider some details from history to avoid unnecessary diagnostic tests.PUBS presentation is generally benign,but is associated with high morbidity and mortality due to the backgrounds of the patients.The management involve regular changing of urinary catheters,antibiotics if UTI is demonstrated and laxatives.
Conclusion
In the two cases described,the diagnosis was not controversial because urinalysis,urine and blood culture were positive.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): acute leukemia, Infection
Abstract: PB2045
Type: Publication Only
Background
Purple urine bag syndrome (PUBS) is a rare disorder characterized by purple discoloration of urine inside the urine collection bag and tube.It's usually seen in elderly women with a history of chronic or acute renal failure and constipation during longterm urinary catheterisation.Recognition of this entity is important to minimize concern and distress for patients and their relatives and also to avoid overmanagement.
Aims
CASE 1. An 86 year old woman was hospitalized because of anorexia,fever and asthenia.Her past medical history included arterial hypertension and chronic constipation.Basic investigations were done Hb 91 g/L, platelet count 18x109/L and leucocytes 41.6 K/mcL. The bone marrow smear was compatible with Acute Myelomonocytic Leukaemia (AML) with negative cytogenetic and molecular biology. Due to the elderly conditions of the patient,palliative support treatment was decided.After 72 hours she presented lower abdominal pain with acute urinary retention and a urinary catheter was introduced.During the hospitalization,a purple discoloration of the urine bag and tube was noted.Urine examination showed urine leucocytes without RBC’s with multi sensitive E. Coli on the urine culture.She was started on parenteral Ciprofloxacin and the catheter was changed,the purple urine returned to its normal colour but she died 48 hours later. CASE 2.An 88 year old woman was admitted to the Palliative Care Unit because of fever and dysuria in the context of neutropenia grade IV and severe constipation during the preceding days.Her past medical history included AML with normal karyotype and high rated FLT3-ITD diagnosed 6 months apreviously.She was receiving palliative support due to her age.On admission,she was found to have bleeding diathesis and acute urinary retention.Pan-sensitive E.coli was isolated from blood and urine cultures.She was treated with intravenous Ciprofloxacin, urine catheterisation and laxatives.48 hours later, she developed severe sepsis with hemodynamic instability and refractory hypotension.The urine in the bag was strikingly purple in colour.Because of the refractory sepsis condition and a terminal AML diagnosis,finally died 72 hrs after admission.
Methods
PUBS is a rare phenomenon where urine in catheter bags and tubing turns purple. The prevalence is unknown, range estimate between 8.3% and 42.1%.
Results
PUBS occurs when the pigments indigo and indirubin,products of bacterial sulphatase and phosphatase mediated tryptophan metabolism,accumulate in the urine and cross react with the PVC of catheter tubing to produce a purple hue.These bacteria include Providencia spp,Citrobacter spp,Klebsiella pneumoniae,Proteus spp,Escherichia coli,Enterococcus spp,Morganella morganii,Pseudomonas aeruginosa and B Streptococci.The principal PUBS risk factors include elderly patients,renal disease,chronic catheterisation,dehydratation,severe constipation,increased dietary thryptophan,high urinary bacterial load and urine alkalinity.There are several causes that change the urine colour:food dyes,drugs,haematuria,myoglobinuria,nephrolithiasis and poisons so it’s important to consider some details from history to avoid unnecessary diagnostic tests.PUBS presentation is generally benign,but is associated with high morbidity and mortality due to the backgrounds of the patients.The management involve regular changing of urinary catheters,antibiotics if UTI is demonstrated and laxatives.
Conclusion
In the two cases described,the diagnosis was not controversial because urinalysis,urine and blood culture were positive.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): acute leukemia, Infection