Search form

Topics:

ubmslateCL-logo-ubm

CL Mobile Menu

Pursuit of the Pink Diaper: A Medical Mystery

Pursuit of the Pink Diaper: A Medical Mystery


  • An 8-wk-old infant is rushed to PACC after his mother finds a diaper that has become pink while sitting in the diaper pail. Hx: born 6 weeks prematurely, treated for long course of neonatal pneumonia.

  • At home, infant was doing well, breast feeding appropriately but a pinkish-red diaper, discarded after stool had been removed, unnerved the mother.

  • Physical exam was normal so the following tests were ordered: CBC; catheterized urine for UA/culture; culture of still moist diaper; rectal culture.

  • Lab results CBC, normal; UA, normal… no hematuria on dip stick, no RBCs viewed microscopically; other culture results, pending.

  • Clinical suspicion pointed to a non-urgent cause but child was hospitalized pending results of all tests ordered.

  • Summary of current knowledge: infant was significantly ill at birth, treated extensively with antibiotics; entirely well upon d/c; breast feeding/no nipple fissures; diaper undeniably pink.

  • Differential diagnosis: Medication-induced coloration; foods via maternal breast milk; intravascular hemolysis; other medical condition (eg porphyria); myoglobinuria; red diaper syndrome from Serratia marcesans

  • Microbiology lab showed us the urine culture plate and the rectal swab plate.

  • Culture revealed the gram negative organism known as Serratia marcescens.

  • Diagnosis: Red diaper syndrome caused by Serratia marcescens.

A brief preface to the case from the author: Like many Navy physicians, even though I was a subspecialist in adolescent medicine, I had call or was asked to help out several times a month in the pediatric acute care clinic (PACC). I did not mind that much as I had been a general pediatrician for 13 years when I finally decided to do my subspecialty. I wavered between pediatric dermatology and adolescent medicine, but adolescent medicine finally won out.

I trained at a time when we did much of our own lab work, including microbiology, and I had become quite adept in that field of study. I felt this provided me with a more holistic approach to solving medical mysteries.

The case you'll follow above, I think, will prove my point. Resources are below, but read the case to the end, first.

 

 

 

Resources

Mahlen SD. Serratia infections: from military experiments to current practice. Clin  Microbiol Rev. 2011;24:755- 791.

Yu VL. Serratia marcescens-historical perspective and clinical review. N Engl J Med. 1979; 300:887-893.

For additional reading please see references cited in the case "A Tale of Two Urines."

Comments

I apologize if there is any confusion. I had hoped the audience had read my previous case about Pink Diaper. That was the basis for this follow up case. The labs in this present case were much the same. So, the cath urine culture was no growth. The rectal culture and the culture from the wet diaper grew Serratia. I was aware that Serratia was know to grow out with red colonies (but could appear to be pink on a white background. I don't think you will see this a lot, but it is a good thing to know even in adults. It is a "water bug" and is seen in moist environments such as respiratory care. I saw a few cases during my internship and it is a terrible bacteria to treat if it is in the blood stream.
Jon Schneider, author

Jonathan @

Hi
Maybe some sort of dyes in food.

Babak @

Unfortunately I can only view 3 slides.

Babak @

Porphyria

Anonymous @

What about looking for uric acid /urate crystals
They also give a pinkish color to the diaper
Does the child need any antibiotics since it seems urine culture poditive

Nuzhat @

I also thought about uric acid crystals...

Celina @

Part of our UA and in view of the previous case of pink urine, we did look for Uric acid crystals and that was eliminated from our diagnosis. The cath urine was no growth... so, UTI was also considered, but eliminated. The serratia grew from a culture of the wet diaper. I hope this clarifies your questions
Jon Schneider, author

Jonathan @

What about looking for uric acid /urate crystals
They also give a pinkish color to the diaper
Does the child need any antibiotics since it seems urine culture poditive

Nuzhat @

Add new comment

 
Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.