A 78-year-old woman, 40 kg, 1.65 m tall, with a history of gastric ulcer gastrectomy with Billroth II reconstruction more than 30 years ago, who later became a Roux-en-Y gastric reflux.
A year later, the patient began with suboptimal symptoms and required surgery for intestinal obstruction.
Secondarily, he presents malnutrition with severe hypoalbuminemia, anemia of severe chronic disorders, pressure ulcers in the sacral region and heels, urinary incontinence and immobility syndrome.
It also highlights renal TBC for more than 20 years, with recurrent pyelonephritis, which required surgery for ureteral stenosis.
She was admitted for anemization with a hemoglobin of 4.8 g/dl (VN: 12-18 gr/dl) secondary to digestive bleeding.
He had severe protein-calorie malnutrition (BMI: 14.7 kg/m2), with albumin of 2.48 g/dl (VN: 3.30-5.20 g/dl).
Upon admission, a urinary catheter was placed in a voiding blanket.
Three months before, she had been admitted due to anasarca in relation to malnutrition due to malaractive syndrome, and at that time the administration of hypercaloric/hyperproteic nutritional supplements was started every 8 hours.
Table I shows the improvement of biochemical nutritional markers from this first admission and the beginning of nutritional supplements until hospital discharge.
During the first admission, a vesical catheter was required to control diuresis, which was subsequently maintained to favor the healing of ulcers in the sacral region.
Shortly before discharge, the morado color of the urine was observed on the probing bag, so that empirically the medication was administered on a long schedule due to suspicion of urinary tract infection.
In the present admission, the persistence of the morado color of urine in the bladder catheter bag despite antibiotic treatment is evident.
The patient describes having noticed this change in color from the previous discharge and that it persists after changing it, reappearing three or four days after each change.
There was no fever or leukocytosis at any time.
The biochemical analysis of urine shows alkaline pH (8.5), which can also be observed in the analysis of previous months.
Also in the sediment are amonic phosphate crystals magnified, 10-25 leukocytes per field and abundant bacteriuria.
The nitrite reaction is negative.
Proteus vulgaris resistant to clarithromycin was isolated in the urine culture.
Treatment with ciprofloxacin (sensitive according to antibiogram) and change of bladder catheter was initiated.
At 48 hours urine acquires a normal color.
