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doi:10.1016/j.cca.2006.11.015 
Copyright © 2006 Elsevier B.V. All rights reserved.
Case report
Mass spectrometry analysis of urine and catheter of a patient with purple urinary bag syndrome
David Bar-Ora, b, 
, 
, Leonard T. Raela, b, Raphael Bar-Ora, b, Michael L. Craunc, Jessica Statzd and Raymond E. Garrettc
Received 25 July 2006;
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Abstract
Introduction
Purple urinary bag syndrome (PUBS) is considered to be a benign condition observed in the urinary catheter and bag in some catheterized patients with urinary tract infections. This syndrome is usually reported to occur in alkaline urine.
Case report
We report of a catheterized patient with PUBS and slightly acidic urine (pH 6–6.5). A novel analysis method was developed using high pressure liquid chromatography and mass spectrometry (HPLC/MS) to detect compounds that are thought to be associated with PUBS. Urine, urinary sediment, and the plastic collection system were assayed and quantitated using these methods. The potential toxicity of one of these compounds, indoxyl sulfate, is discussed.
Conclusions
The presence of PUBS in a catheterized patient with slightly acidic urine is reported. A novel method for the analysis of chemical components of PUBS and the first direct confirmation of the presence of indigo in the urine sediment and collecting system are described.
Keywords: Urinary tract infection; Purple urinary bag syndrome (PUBS); Tryptophan metabolism; Indoxyl sulfate; Mass spectrometry; Indigo
