A rare presentation of tuberculous prostatic abscess in young patient

Genitourinary tuberculosis contributes 15-20% of extra pulmonary tuberculosis. Prostatic tuberculosis is much less common than renal, vesico-seminal and epididymal TB. Predisposing factor include prior tubercular infection, immunocompromised status, previous BCG therapy. Nevertheless, isolated tuberculous prostatic abscess are uncommon especially in immunocompetent patient.

We report a case of tuberculous prostatic abscess in young, healthy immunocompetent patient, from India, who has initial presentation of pyrexia of unknown origin. All his investigation and treatment were done in India. He was diagnosed with prostatic abscess, treated with TRUS guided aspiration and antituberculous drugs. But he did not respond to the treatment and later on presented as extraprostatic extension of abscess and rectal sinus, a rare complication. MRI revealed this finding. Sigmoidoscopy was done and in same sitting we drained the abscess through perineal route. ATT was continued and he responded to treatment.

Urogenital tuberculosis most frequently affects the kidneys. Ureter and bladder tuberculosis is secondary to descending infection. Prostate tuberculosis is usually asymptomatic and as an incidental prostatectomy finding. Prostatic abscess is rare but occur in AIDS patients with urogenital TB. Prostatic tuberculous cavities or abscesses may discharge into the surrounding tissues, forming sinuses or fistulae to the perineum or rectum and are demonstrated best on MRI scans.

Tuberculous prostatic abscess although very uncommon in immunocompetent patient, we should have high index of suspicion in patients of PUO. Once diagnosed it should be treated with complete drainage of abscess and ATT with close follow up.