An elderly nursing home resident with unusual urine bag discoloration

A bedridden 75-year-old male with a history of end-stage renal disease, diabetes mellitus, hypertension and stroke was transferred from a nursing home to hospital due to an unusual discoloration of his Foley catheter bag. He was on long-term catheterization for chronic urinary retention secondary to degenerative spine disease. Past medical history also included recurrent hospital admissions for chronic constipation and urinary tract infections (UTIs) over the past 2 years. On physical examination, patient appeared non-toxic, afebrile with blood pressure reading of 176/87 mmHg. Capillary blood sugar was 8.3 mmol/L. Cardiovascular, respiratory and abdominal examination was unremarkable. His urinary tube and bag was noted to be discolored, with cloudy urine seen (Figure 1). Laboratory investigations revealed a white blood cell (WBC) count of 10 330/mm, Hemoglobin 9.1 g/dL and C-reactive protein 33 mg/L. Urinalysis showed pyuria of WBC >2000/UL and microorganism 21.