Recurrent purple urine bag syndrome presenting with full spectrum of disease severity: case report and review of literature.

Purple urine bag syndrome (PUBS) is a unique phenomenon characterized by purple discoloration of the urinary catheter bag and tubing following urinary catheterization lasting for hours to days. The purple discoloration is a mixture of indirubin dissolved in plastic with indigo on its surface. PUBS is most commonly associated with urinary tract infection (UTI) caused by bacteria with indoxyl phosphatase/sulfatase activity. It occurs predominantly in chronically catheterized, constipated elderly female patients. It usually appears to be asymptomatic and harmless, but rarely it can present as a severe illness. We report on a 29-year-old female with urinary ileal diversion presenting with multiple episodes of PUBS each with an asymptomatic state of varying severity, symptomatic UTI and severe sepsis requiring intensive care. To our knowledge, this is the first report where a single young patient had recurrent PUBS which presented with a full spectrum of disease severity at different occasions.