<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932025000100418</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2025.e12142518</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Dualidad cromática urinaria en un adulto mayor con cáncer vesical avanzado: manifestación parcial del síndrome de la bolsa urinaria púrpura]]></article-title>
<article-title xml:lang="en"><![CDATA[Urinary chromatic duality in an elderly adult with advanced bladder cancer: partial manifestation of purple urinary bag syndrome]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Damián-Mucha]]></surname>
<given-names><![CDATA[Milagros]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Solari Yokota]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Takami Ángeles]]></surname>
<given-names><![CDATA[Graciela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arroyo Zevallos]]></surname>
<given-names><![CDATA[Carla]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peña Cucho]]></surname>
<given-names><![CDATA[Elena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Torres-Salinas]]></surname>
<given-names><![CDATA[Carlos Hugo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Nacional &#8220;Edgardo Rebagliati Martins&#8221; Unidad de Geriatría ]]></institution>
<addr-line><![CDATA[Lima ]]></addr-line>
<country>Perú</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Continental Facultad de Medicina Humana ]]></institution>
<addr-line><![CDATA[Lima ]]></addr-line>
<country>Perú</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>12</volume>
<numero>1</numero>
<fpage>418</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932025000100418&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932025000100418&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932025000100418&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN El síndrome de la bolsa urinaria púrpura (PUBS) es una manifestación infrecuente asociada a infecciones urinarias crónicas en pacientes con catéteres, especialmente adultos mayores. Presentamos el caso de una mujer de 79 años con cáncer vesical avanzado y doble derivación urinaria (urostomía tipo Bricker y nefrostomía derecha), quien desarrolló PUBS exclusivamente en la urostomía, evidenciándose una llamativa dualidad cromática urinaria. Esta observación sugiere un papel fisiopatológico predominante del reservorio vesical, influenciado por el microbioma local, el pH urinario, el material colector y la exposición al oxígeno. El urocultivo aisló Escherichia coli, con respuesta favorable a ceftriaxona. Este caso amplía la comprensión del PUBS desde un enfoque geriátrico, oncológico y microbiológico, y plantea un modelo in vivo para estudiar los factores locales que determinan su expresión. Reconocer esta condición en cuidados paliativos permite intervenciones proporcionales, evitando tratamientos innecesarios y priorizando el confort del paciente frágil.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Purple urinary bag syndrome (PUBS) is a rare condition associated with chronic urinary tract infections in patients who use catheters, particularly older adults. We present the case of a 79-year-old woman with advanced bladder cancer and double urinary diversion (Bricker-type urostomy and right nephrostomy), who developed PUBS exclusively in the urostomy, showing a striking urinary chromatic duality. This observation suggests a predominant pathophysiological role of the bladder reservoir, influenced by the local microbiome, urinary pH, collection material, and exposure to oxygen. Urine culture isolated Escherichia coli, with a favorable response to ceftriaxone. This case broadens the understanding of PUBS from a geriatric, oncological, and microbiological perspective and proposes an in vivo model for studying the local factors that determine its expression. Recognizing this condition in palliative care allows for proportionate interventions, avoiding unnecessary treatments and prioritizing the comfort of the frail patient.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[orina]]></kwd>
<kwd lng="es"><![CDATA[cistostomía]]></kwd>
<kwd lng="es"><![CDATA[neoplasias de la vejiga urinaria]]></kwd>
<kwd lng="es"><![CDATA[adulto mayor.]]></kwd>
<kwd lng="en"><![CDATA[urine]]></kwd>
<kwd lng="en"><![CDATA[cystostomy]]></kwd>
<kwd lng="en"><![CDATA[urinary bladder neoplasms]]></kwd>
<kwd lng="en"><![CDATA[older adult.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Camarinha]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Sevivas]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Reis]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Purple urine bag syndrome]]></article-title>
<source><![CDATA[Cureus]]></source>
<year>2024</year>
<volume>16</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Domínguez Alegría]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Vélez Díaz-Pallares]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Moreno Cobo]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Arrieta Blanco]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Bermejo Vicedo]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Síndrome de la orina morada en bolsa en paciente anciana con suplementos nutricionales]]></article-title>
<source><![CDATA[Nutr Hosp]]></source>
<year>2012</year>
<volume>27</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>2130-2</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Villarraga Márquez]]></surname>
<given-names><![CDATA[NJ]]></given-names>
</name>
<name>
<surname><![CDATA[Franco Pineda]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Guarín Loaiza]]></surname>
<given-names><![CDATA[GM]]></given-names>
</name>
<name>
<surname><![CDATA[Jurado Bastidas]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Castillo Mercado]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Síndrome de la bolsa de orina púrpura]]></article-title>
<source><![CDATA[Rev colomb nefrol]]></source>
<year>2021</year>
<volume>8</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zanetti]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ku]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Ruíz]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Síndrome de la bolsa de orina púrpura]]></article-title>
<source><![CDATA[Cuad. med. forense]]></source>
<year>2012</year>
<volume>18</volume>
<numero>3-4</numero>
<issue>3-4</issue>
<page-range>153-6</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Graboski]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Kowalewski]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Simpson]]></surname>
<given-names><![CDATA[JB]]></given-names>
</name>
<name>
<surname><![CDATA[Cao]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Ha]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Mechanism-based inhibition of gut microbial tryptophanases reduces serum indoxyl sulfate]]></article-title>
<source><![CDATA[Cell Chem Biol]]></source>
<year>2023</year>
<volume>30</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1402-13.e7</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Chaudhry]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Qureshi]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Cowley]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Purple urine bag syndrome]]></article-title>
<source><![CDATA[Int J Nephrol]]></source>
<year>2011</year>
<volume>2011</volume>
<page-range>419213</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hadano]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Shimizu]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Takada]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Inoue]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Sorano]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[An update on purple urine bag syndrome]]></article-title>
<source><![CDATA[Int J Gen Med]]></source>
<year>2012</year>
<volume>5</volume>
<page-range>707-10</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Karim]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Abed]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Bachuwa]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A unilateral purple urine bag syndrome in a patient with bilateral nephrostomy tubes]]></article-title>
<source><![CDATA[BMJ Case Rep]]></source>
<year>2015</year>
<volume>2015</volume>
<page-range>bcr2015212913</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Goyani]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Christodoulou]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Vassiliou]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Immunosenescence]]></article-title>
<source><![CDATA[Vaccines]]></source>
<year>2024</year>
<volume>12</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>1314</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ligon]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[ChS]]></surname>
<given-names><![CDATA[Joshi]]></given-names>
</name>
<name>
<surname><![CDATA[Fashemi]]></surname>
<given-names><![CDATA[BE]]></given-names>
</name>
<name>
<surname><![CDATA[Salazar]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Mysorekar]]></surname>
<given-names><![CDATA[IU]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effects of aging on urinary tract epithelial homeostasis and immunity]]></article-title>
<source><![CDATA[Dev Biol]]></source>
<year>2023</year>
<volume>493</volume>
<page-range>29-39</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Pan]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Yan]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Jin]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The inflammatory microenvironment and the urinary microbiome in the initiation and progression of bladder cancer]]></article-title>
<source><![CDATA[Genes Dis]]></source>
<year>2021</year>
<volume>8</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>781-97</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Patel]]></surname>
<given-names><![CDATA[PK]]></given-names>
</name>
<name>
<surname><![CDATA[Advani]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
<name>
<surname><![CDATA[Kofman]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Lo]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Maragakis]]></surname>
<given-names><![CDATA[LL]]></given-names>
</name>
<name>
<surname><![CDATA[Pegues]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals]]></article-title>
<source><![CDATA[Infect Control Hosp Epidemiol]]></source>
<year>2023</year>
<volume>44</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>1209-31</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
