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Purple Urine Bag Syndrome Chronic, indwelling catheter + bacteriuria (Providencia, Klebsiella, E.coli*) + alkaline urine Tryptophan → Indoxyl sulfate → Sulfatase enzyme (bacteria* ) → Indigo (blue) + Indurubin (red) - BWH Medicine Chiefs @BrighamChiefs #Purple #Urine #Bag #Syndrome #PUBS #pathophysiology #clinical #photo #differential #diagnosis