Photo Quiz

Unusual Urine Color During Catheterization


Am Fam Physician. 2016 Oct 1;94(7):572-574.

A 50-year-old woman presented for a routine catheter change. The patient was wheelchair-bound because of a history of transverse myelitis. She had urinary incontinence and was dependent on chronic urinary catheterization. The patient had no symptoms beyond discolored urine. There was no dysuria or blood around the catheter. She had no history of trauma to the catheter.

On examination, she was afebrile and well appearing, but the urine in her catheter bag looked purple (Figure 1). She did not know how long her urine had been discolored. Urinalysis showed leukocytes and microscopic hematuria. The urine was sent for culture.

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Figure 1.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Excessive blackberry or beet consumption.

B. Familial benign hyperca

Address correspondence to Michael D. Burg, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Hadano Y, Shimizu T, Takada S, Inoue T, Sorano S. An update of purple urine bag syndrome. Int J Gen Med. 2012;5:707–710....

2. Ribeiro JP, Marcelino P, Marum S, Fernandes AP, Grilo A. Case report: purple urine bag syndrome. Crit Care. 2004;8(3):R137.

3. Pillai RN, Clavijo J, Narayanan M, Zaman K. An association of purple urine bag syndrome with intussusception. Urology. 2007;70(4):812.e1–2.

4. Pillai BP, Chong VH, Yong AM. Purple urine bag syndrome. Singapore Med J. 2009;50(5):e193–e194.

5. Chong VH. Purple urine bag syndrome: it is the urine bag and not the urine that is discolored purple. South Med J. 2012;105(8):446.

6. Aycock RD, Kass DA. Abnormal urine color. South Med J. 2012;105(1):43–47.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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