68 y/o man with HIV is on a stable regimen of Biktarvy (Tenofovir alafenamide, Emtricitabine and  Bicetegravir) has a CD4 count of 650 and an undetectable viral load.

Several months ago he was diagnosed with bladder cancer and because of an obstructive uropathy, a total cystectomy was done and bilateral nephrostomies were placed. He did well until he noticed that his urine had turned purple in color.

On Review of Systems he denied any fever, chills or headaches. There were no respiratory, cardiac, or gastrointestinal symptoms. He had no rashes or arthralgias.

On Physical Exam his vital signs were stable, lungs were clear, heart without murmur. His abdomen was benign with a well healed cystectomy scar and nephrostomy tubes that were not inflamed.

His WBC was 12,000 with a normal differential, hemoglobin 12, hematocrit 34 and his platelet count was 250,000. His chemistries were all normal with a BUN of 30 and a creatinine of 1.8. His UA had 50-100 WBC’s, 10-15 RBC’s and a positive leukocyte esterase. The urine culture showed 100,000 colonies of Providencia stuartii, Klebsiella pneumoniae and Pseudomonas aeruginosa. His CXR was read as normal.