Purple urine bag syndrome in a young man with paraplegia in Bhutan: a case report

Abstract

Purple urine bag syndrome is an uncommon clinical phenomenon characterized by purple discolouration of the urinary catheter bag. It typically affects elderly, immobilized, and co-morbid patients on long-term urinary catheters. The purple discolouration is due to the production and mixing of pigments indirubin and indigo in the presence of bacteria in the urine. While often benign and asymptomatic, it can signal an underlying urinary tract infection and has been associated with severe complications. We present the case of a 20-year-old man with paraplegia on a permanent suprapubic catheter,  who developed purple urine bag syndrome  accompanied by systemic signs of infection. His urine culture identified Staphylococcus aureus,  an organism not frequently associated with the condition. The patient achieved full recovery with no recurrence during follow-up. Healthcare providers need to be aware of this condition to ensure timely recognition, assessment, and appropriate management.