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PUBS remains rare in the African literature. We report, to the best of our knowledge, the first case of this phenomenon from Central Africa.
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An year-old female Cameroonian, known hypertensive on aspirin, amlodipine, and lisinopril hospitalized 3 months previously for an ischemic stroke, was brought to our unit 10 weeks after her prior discharge with a history of a purple discoloration of her urine bag, abdominal pain, and fever for 24 h.
She had missed her followed up visit for the replacement of her urinary catheter 9 weeks earlier due to financial constraints. She was also bedridden, developed urinary incontinence, and chronic constipation as sequelae of the stroke. The plastic urine bag and tube were seen with a purple discoloration [ Figure 1 ] even though her urine had an amber yellow. The rest of the examination was unremarkable. Her urinalysis was positive for leukocyte esterase and nitrites, with a pH of 8.
Urine culture was positive for Escherichia coli. The indwelling catheter was changed and she was placed on laxatives, diet and hygiene modification washing of hands before and after touching the catheter; washing the skin around catheter with soap and water daily, and after each bowel movement , and intravenous amoxicillin-clavulanate 1 g every 8 h.
On the third day of admission, symptoms resolved and she was discharged 2 days later on the same antibiotics per os to complete a day course of treatment. She returned for a follow-up visit a week later, then every 2 weeks for 6 weeks with no resurgence of symptoms. PUBS is a rare phenomenon first described in by Barlow.
Even though PUBS is a rare pathology, recent studies have shown a higher prevalence of 8. PUBS has been associated with the following risk factors; being elderly, female gender, bedridden states, constipation, chronic urinary catheterization, alkaline urine, UTI, and kidney failure. Our patient had risk factors consistent with the aforementioned predisposing her to this rare syndrome such as her age 80 years , sex female gender , bedridden state, alkaline urine, chronic catheterization, constipation, and a UTI due to E.
Furthermore, the poor hygienic care afforded to our patient coupled with her poor economic status which allowed her to carry the same catheter for 10 weeks greatly contributed to the development of this rare entity. The pathogenesis of PUBS involves deamination of dietary tryptophan to indole by bacteria in the gut, which is usually favored by constipation. Indole is then conjugated in the liver to indoxyl sulfate indican , which is then excreted in urine.
An underlying renal failure will impair the clearance of indican, hence favoring the development of PUBS. When these pigments get in contact with a plastic urine bag or tubing, it produces a purple discoloration of the urine bag. Even though alkaline urine has been reported by a majority of authors to be a risk factor for the development of PUBS, 1 , 2 , 6 , 7 , 8 it has also been described in patients with acidic urine.
Although most of the reported cases of PUBS are benign, 5 , 6 , 11 some reports have associated PUBS to severe complications such as severe sepsis requiring aggressive treatment in the intensive care unit 8 and Fournier's gangrene in an immunocompromised patient. The treatment generally involves controlling underlying risk factors, avoiding chronic catheterization, and proper urologic sanitation in patients with PUBS.
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Antibiotic treatment is only recommended for patients with symptomatic UTI. Her urine culture revealed the presence of E. Diet modification limiting consumption of foods rich in tryptophan , proper hygiene, and psychological support were instrumental in the management.
PUBS is a rare condition, especially to the African literature associated with significant anxiety for both patients and caregivers. It is benign and resolves with appropriate management. Awareness of this syndrome among health-care providers in Africa is important so as to adequately manage the condition, while providing psychosocial support. The authors certify that they have obtained all appropriate patient consent forms.
The patient understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. National Center for Biotechnology Information , U. Journal List Niger Med J v.
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Niger Med J. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4. Abstract Purple urine bag syndrome is a rare clinical entity commonly seen in elderly females with a long-term urinary catheterization. Keywords: Cameroon, chronic indwelling catheter, purple urine bag syndrome.