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Purple Urine Bag Syndrome Caused by Klebsiella pneumoniae in an Elderly Patient: A Case Report

Botuku S, Garre SMK, Muppavarapu RS, Yedida N, Gundraju S, Suvvari TK, Singh T

Clinical medicine insights. Case reports, 2025

Abstract

Purple Urine Bag Syndrome (PUBS) is an uncommon but notable clinical phenomenon primarily observed in patients with long-term indwelling catheters. This syndrome is characterized by a striking purple discoloration of the urine collection bag, often indicative of an underlying urinary tract infection (UTI) and associated metabolic processes. PUBS occurs due to the breakdown of indoxyl sulfate, a tryptophan metabolite, by specific bacteria present in the urinary tract. In this report, we present the case of a 73-year-old female with a chronic Foley's catheter, later developed PUBS, accompanied by symptoms of lower abdominal pain, fever, and reduced urine output. Urine culture identified Klebsiella pneumoniae, a common uropathogen, as the causative organism. This case highlights the clinical presentation, pathophysiology, and management of PUBS in a patient with long-standing catheterization, along with a brief review of existing literature on the condition. Prompt recognition and targeted antibiotic therapy, alongside supportive measures, were essential in managing the infection and alleviating symptoms.

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