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A staff nurse calls the physician to see "something really bizarre—we have no idea what this is": the plastic of a urine collection bag of an 81-year-old woman has turned purple, although the urine within is more orange-brown and distinctly less odd looking. Patient has had an indwelling urethral catheter for 7 months, and this discoloration had not been noted before. Current history includes marked constipation, atrial fibrillation, and symptomatic osteoarthrosis of the hips and knees.
Patient is lucid but frail; says she has felt mild suprapubic tenderness on and off for the past month. Temperature is 38°C (100.4°F).