Purple Urine in a Patient after Recovery from a SARS-CoV-2 I
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A 96-year-old woman living in a nursing home was admitted to hospital due to an infection with SARS-CoV-2. She presented with fever, coughing, and reduced general condition. Under symptomatic therapy, the patient's condition improved. After two weeks, she developed fever again and her urine turned purple. Based on fever (39·2°C), increased C reactive protein levels (27.5 mg/L; upper limit of normal: 5 mg/L), leukocyturia, and detection of proteus mirabilis in the urine culture a urinary tract infection was diagnosed.

This diagnosis in combination with an purple urine is typical for a purple-urine-bag-syndrome (PUBS). The purple color result from bacteria metabolizing indoxyl sulphate to indoxyl, which is oxidized to indirubin (red pigment) and indigo (blue pigment). Immobility, advanced age and female gender are risk factors for urinary tract infections in general. This patient had constipation for several days, which presumably leads to increased bacterial conversion of tryptophan to indole in the gut. Indole is absorbed through the intestine, metabolized in the liver to indoxyl sulphate, and excreted through the kidney, promoting the occurrence of PUBS.

Others suggested that a lying urinary catheter also supports urine discoloration in PUBS. Typical differential diagnoses include adverse effects of drugs (e.g. rifampicin), hematuria, rhabdomyolysis, porphyria, and the consumption of beetroot. Authors excluded these diagnoses by taking medical history and further laboratory diagnostics. The urine color normalized after exchange of the urine bag and a calculated antibiotic therapy with piperacillin/tazobactam (4.5g, 3x per day). The patient was discharged after five days of antibiotic treatment and no readmission was necessary.

In summary, PUBS represents an important differential diagnosis of urinary discoloration and indicates an existing urinary tract infection.

Source: https://www.ijidonline.com/article/S1201-9712(21)00169-7/fulltext?rss=yes
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