A Rare Case of Purple Urine Bag Syndrome Presenting with Delirium and Associated with Acidic Urine and UTI due to Serratia Marcescens: But Do We Still Know Enough?

Purple Urine Bag Syndrome (PUBS) is a rare occurrence characterised by a striking purple to blue/violet discolouration of the urine bag and its tubing after long-term indwelling urinary catheterisation while the urine inside remain clear. This phenomenon is a warning sign of Urinary Tract Infection (UTI). However, unlike traditional UTIs, such patients can be non verbal and asymptomatic with purple/blue urine bag being the only signal for UTI. Tryptophan-Indigo hypothesis is advanced to explain the mystery behind this phenomenon. A rare case of PUBS in acidic urine in an octagenarian (80 years old) female patient, with right sided hemiparesis, hypertension, Post Stroke Aphasia (PSA) and delirium is presented here. Moreover, her urine culture yielded an opportunistic bacteria Serratia marcescens which is not a typical organism responsible for this condition. The bluish colour of urine bag disappeared after hydration, change of the catheter along with urine bag and antibiotic therapy. To the best of the author’s knowledge, this is the first case of PUBS reported from the state of Assam. It is hoped that this case report will be valuable in raising awareness and educating healthcare providers about this rather unknown esoteric syndrome in this region.