Urinary chromatic duality in an elderly adult with advanced bladder cancer: partial manifestation of purple urinary bag syndrome
Abstract
Purple urinary bag syndrome (PUBS) is a rare condition associated with chronic urinary tract infections in patients who use catheters, particularly older adults. We present the case of a 79-year-old woman with advanced bladder cancer and double urinary diversion (Bricker-type urostomy and right nephrostomy), who developed PUBS exclusively in the urostomy, showing a striking urinary chromatic duality. This observation suggests a predominant pathophysiological role of the bladder reservoir, influenced by the local microbiome, urinary pH, collection material, and exposure to oxygen. Urine culture isolated Escherichia coli, with a favorable response to ceftriaxone. This case broadens the understanding of PUBS from a geriatric, oncological, and microbiological perspective and proposes an in vivo model for studying the local factors that determine its expression. Recognizing this condition in palliative care allows for proportionate interventions, avoiding unnecessary treatments and prioritizing the comfort of the frail patient.
References
2. Domínguez Alegría AR, Vélez Díaz-Pallares M, Moreno Cobo MA, Arrieta Blanco F, Bermejo Vicedo T. Síndrome de la orina morada en bolsa en paciente anciana con suplementos nutricionales. Nutr Hosp [Internet]. 2012 [citado 25 Jun 2025];27(6):2130–2. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112012000600045&lng=es&nrm=iso&tlng=es
3. Villarraga Márquez NJ, Franco Pineda SM, Guarín Loaiza GM, Jurado Bastidas S, Castillo Mercado JS. Síndrome de la bolsa de orina púrpura. Rev colomb nefrol [Internet]. 2021 [citado 25 Jun 2025];8(1): e405. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S2500-50062021000100405
4. Zanetti M, Ku V, Ruíz J, González E. Síndrome de la bolsa de orina púrpura. Presentación de un caso. Cuad. med. forense [Internet]. 2012 [citado 25 Jun 2025];18(3–4):153–6. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-76062012000300014&lng=es&nrm=iso&tlng=es
5. Graboski AL, Kowalewski ME, Simpson JB, Cao X, Ha M, Zhang J, et al. Mechanism-based inhibition of gut microbial tryptophanases reduces serum indoxyl sulfate. Cell Chem Biol [Internet]. 2023 [cited 2025 Jun 25];30(11):1402-13.e7. Available from: https://pubmed.ncbi.nlm.nih.gov/37633277/
6. Khan F, Chaudhry MA, Qureshi N, Cowley B. Purple urine bag syndrome: An alarming hue? A brief review of the literature. Int J Nephrol [Internet]. 2011 [cited 2025 Jun 25]; 2011:419213. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3184437/
7. Hadano Y, Shimizu T, Takada S, Inoue T, Sorano S. An update on purple urine bag syndrome. Int J Gen Med [Internet]. 2012 [cited 2025 Jun 25]; 5:707-10. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3437914/
8. Karim A, Abed F, Bachuwa G. A unilateral purple urine bag syndrome in a patient with bilateral nephrostomy tubes. BMJ Case Rep [Internet]. 2015 [cited 2025 Jun 25];2015:bcr2015212913. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4691883/
9. Goyani P, Christodoulou R, Vassiliou E. Immunosenescence: Aging and immune system decline. Vaccines (Basel) [Internet]. 2024 [cited 2025 Jun 25];12(12):1314. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11680340/
10. Ligon MM, Joshi ChS, Fashemi BE, Salazar AM, Mysorekar IU. Effects of aging on urinary tract epithelial homeostasis and immunity. Dev Biol [Internet]. 2023 [cited 2025 Jun 25]; 493:29–39. Available from: https://pubmed.ncbi.nlm.nih.gov/36368522/
11. Huang X, Pan T, Yan L, Jin T, Zhang R, Chen B, et al. The inflammatory microenvironment and the urinary microbiome in the initiation and progression of bladder cancer. Genes Dis [Internet]. 2021 [cited 2025 Jun 25];8(6):781–97. Available from: https://www.sciencedirect.com/science/article/pii/S2352304220301276?__cf_chl_tk=mIdDuvgTcZW4Wf6Lt3P5dPV9UUOSZ52ZBLMLEqFenrg-1750986342-1.0.1.1-a6Dj2ELlS9bMteKiLHomkuc.KYG7BZeNbvE3xc1EQ.E
12. Patel PK, Advani SD, Kofman AD, Lo E, Maragakis LL, Pegues DA, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol [Internet]. 2023 [cited 2025 Jun 25];44(8):1209-31. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11287483/
