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Rheumatologists should be aware of LYG, both as a differential diagnosis in patients with pulmonary nodules with angioinvasive lymphocytic infiltrates, and as a rare complication of immunosuppressive therapy. Chest computed tomography (CT) demonstrated bilateral pulmonary nodules with evidence of central necrosis, predominantly in the middle and lower lobes, and abdominal CT revealed a similar lesion in the right kidney. At this point, differential diagnoses included anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, necrotizing sarcoid granulomatosis, fungal or mycobacterial infection, and lymphomatoid granulomatosis (LYG). [Extracted from the article]

Background: Purple urine bag syndrome (PUBS) can occur in cases of bacteriuria with species expressing enzymes capable of converting tryptophan metabolites to red and blue pigments which are excreted in urine, leaving a characteristic purple colour. Risk factors include urinary catheterisation, constipation and chronic kidney disease. Treatment includes catheter replacement, and antibiotics in case of urinary tract infection., Case Presentation: A man in his 70s with myelodysplastic syndrome, stage 5 chronic kidney disease and chronic indwelling urinary catheterisation due to benign prostatic hyperplasia was admitted for transfusion for symptomatic anaemia. On the second day of hospitalisation, his urine turned purple. There was no sign of transfusion reaction, haemoglobinuria, myoglobinuria or bilirubinuria. Urine cultures were positive for Proteus vulgaris and Enterococcus faecalis, two species associated with PUBS., Interpretation: The constellation was consistent with PUBS. His bacteriuria was considered colonisation not requiring antibiotic treatment. The catheter was replaced and the urine colour returned to normal.