Blue Diaper Syndrome

Hypercalcemia and nephrocalcinosis are associated with a defect in the intestinal transport of tryptophan. Bacterial degradation of the tryptophan leads to excessive indole production and thus to indicanuria which, on oxidation to indigo blue, causes a peculiar bluish discoloration of the diaper. Drummond et al. (1964) reported 2 affected brothers. Although almost certainly recessive, the disorder could be X-linked. Libit et al. (1972) suggested that the blue diaper syndrome can result from blue-green discoloration of the stools by a pigment elaborated by Pseudomonas aeruginosa.