Purple Urine Bag Syndrome and Urological Complications in a Spastic Quadriplegic.
American Journal of Physical Medicine & Rehabilitation
Case Diagnosis: Catheter - Associated Urinary Tract Infection
Case Description: A 42-year-old male with past medical history of spastic quadriplegic cerebral palsy (CP) status post intrathecal baclofen pump (IBP), wheelchair dependency, and neurogenic bladder presented to the emergency department with urine leakage from a previous suprapubic catheter insertion site. The patient also reported purple urine and gross hematuria. The patient’s neurogenic bladder had been managed previously with a suprapubic tube (SPT) for 16 years. His SPT was removed 4 months prior to this ED encounter due leakage, erosion and widening of the stoma secondary to bladder spasticity. Patient underwent cystoscopy with urethral Foley catheter placement at that time. The patient was medically stable with exception of a purple discoloration of urine. Urology was consulted. Workup showed a urinary tract infection (UTI) with Proteus mirabilis infection per culture. PM&R was consulted for IBP refill which had no complications. Patient was discharged to his home.
Discussions: Patients with indwelling catheters are at a high risk of infection. Purple Urine Bag Syndrome from Proteus mirabilis in the patient resulted from urethral catheter use. The patient’s neurogenic bladder was effectively managed for 16 years with a SPT and only required urethral catheterization due to long term complications from bladder spasticity. Infection and chronic colonization can increase spasticity and should be treated when clinically indicated. There are multiple medical complications associated with both SPT and indwelling urethral catheters.
Conclusions: Bladder dysfunction from loss of supraspinal control results in higher rates of UTIs, hospitalizations, healthcare costs and a decrease in quality of life. Prevention of skin breakdown can be complicated and require an interdisciplinary management in wheelchair dependent patients. PM&R often serves as the primary advisor for patients with CP and other neurologic conditions and should discuss erosion and stoma widening as potential complications when recommending SPT for bladder management.
Sankovic R, Reyes A, Shah V, Smith R, Roskos PT. Purple urine bag syndrome and urological complications in a spastic quadriplegic. Am J Phys Med Rehab. 2021;100(4 suppl.):a105.