Purple urine bag syndrome: A case report.

INTRODUCTION: Purple Urine Bag Syndrome (PUBS) is purple discoloration of urine and is common in bedridden patients with long-term urinary catheter. Although typically benign, the purple discoloration is alarming to both the patients and their attendants. CASE REPORT: This case report presents an uncommon case of PUBS in a 74-year-old lady with hypertension, type II diabetes and ischemic stroke from last 2 years. She has neurogenic bladder and has been catheterized from last 2 years. Her last catheter was changed 15 days back. She presented to the emergency room with complaints of change in color of urine with low grade fever from last 1 week. on clinical examination there was one bed sore on lumbar region that was grade 1 with pus oozing from base of ulcer. CLINICAL DISCUSSION: PUBS is generally associated with alkaline urine and in patients who was chronically catheterized as was observed in this patient, although it has also been reported in acidic urine. CONCLUSION: PUBS is a rare manifestation of urinary tract infection with an alarming appearance and can be a source of anxiety for patients and their families. Being asymptomatic and comparatively benign, purple discoloration is simply an indicator of underlying bacteriuria and is of no prognostic value.

Pseudotumour cerebri in acute promyelocytic leukemia on treatment with all-trans-retinoic acid (ATRA) - an experience from a tertiary care centre.

Acute promyelocytic leukemia (APML) is considered to be sensitive to all-trans-retinoic acid (ATRA) which acts as a differentiating agent. ATRA is considered to be a well-tolerated agent and is known to achieve complete remission in acute promyelocytic leukemia. However, a few cases on long term all-trans-retinoic acid (ATRA) use can develop pseudotumor cerebri. Out of 32 patients with APML who were treated in our Centre over a 4-year-period, we encountered 6 patients who developed ATRA-related pseudotumor cerebri while on maintenance treatment. The patients ranged from 12 to 40 years of age. 3 patients complained of unbearable headache, 2 of diplopia and 1 of gross reduction in visual acuity. CT scans and MRI did not reveal any intracranial lesions. Cerebrospinal fluid (CSF) examination was normal with CSF manometry revealing a high CSF pressure (average of 345mmH2O). Fundoscopy revealed papilledema in 5 patients and optic atrophy in 1 patient. The patients were successfully managed with decrease dose/discontinuation of ATRA, use of acetazolamide, corticosteroids and therapeutic CSF drainage.