A case report of purple urine bag syndrome associated with Morganella morganii in an acute care setting

Purple urine bag syndrome (PUBS) is a rare but benign clinical condition associated with urinary tract infection (UTI), classically described in geriatric patients with immobility, dementia, prolonged indwelling urinary catheter, chronic kidney disease, and female gender. We describe a case of an elderly gentleman presenting with an acute onset delirium and newly diagnosed Parkinsonism. Two days after catheterization, the urine colour changed to an alarming bright purple. Urine examination was suggestive of significant bacteriuria with alkaline pH and culture showing growth of Morganella morganii . Further incubation showed additional growth of Enterococcus faecalis . Though known as an unusual opportunistic pathogen, M. morganii is associated with both prostatitis and PUBS. Our patient had moderate prostatomegaly, but no history of antibiotic exposure or prior indwelling catheter use. Culture-sensitive antibiotic treatment and changing of urinary catheter along with tube-bag set led to complete recovery of UTI in our patient. This is a rare case of PUBS with an atypical organism in a patient without a prior history of prolonged immobility or long-term indwelling catheter use. • Geriatric patients with multiple comorbidities may not present with classical signs and symptoms of UTI. • PUBS is rarely observed and can cause significant concern among physicians unfamiliar with this phenomenon. • PUBS is benign; underlying UTI needs prompt attention. • PUBS may rarely present in acute clinical settings in a healthy elderly person without chronic catherization, kidney disease.