Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an
Ryuichi Ohta1, Shuzo Hattori2, Keita Inoue3
1Communiy Care, Unnan City Hospital, Unnan, JPN.
Abstract:
Prostate abscesses often occur in immunocompromised individuals. Contrast-enhanced imaging tests can aid diagnosis; however, they can be difficult to perform in older patients with renal insufficiency. Various organisms can cause prostate abscesses, and poor antibiotic penetration into the prostate can hinder treatment. Here, we report a case of prostate abscess manifesting as fever of unknown origin. The patient, a 78-year-old man with a history of heart failure, renal failure, and liver cirrhosis, presented with dyspnea and fever. He was initially diagnosed with aspiration pneumonia. However, the fever persisted, and urinary tract infection was diagnosed and treated with antibiotics and antifungal drugs. Further investigation with contrast-enhanced computed tomography revealed a prostate abscess. This case demonstrates the importance of aggressive investigation of fever of unknown origin in older patients with renal insufficiency. Furthermore, the problem of tissue penetration of antimicrobial agents should be thoroughly considered when treating prostate abscesses.
Insights
Prostate abscesses can present as fever of unknown origin in elderly patients with renal insufficiency. Aggressive investigation and consideration of antibiotic penetration are crucial for diagnosis and effective treatment.
Area of Science:
- Urology
- Infectious Diseases
- Geriatrics
Background:
- Prostate abscesses are uncommon but serious infections, often seen in immunocompromised individuals.
- Diagnosis can be challenging in elderly patients with comorbidities like renal insufficiency, where contrast-enhanced imaging may be contraindicated.
- Treatment is complicated by poor antibiotic penetration into prostate tissue.
Observation:
- A 78-year-old male with heart failure, renal failure, and liver cirrhosis presented with fever and dyspnea, initially suspected as aspiration pneumonia.
- Persistent fever led to a diagnosis of urinary tract infection, treated empirically with antibiotics and antifungals.
- Contrast-enhanced computed tomography (CT) ultimately identified a prostate abscess.
Findings:
- The case highlights a prostate abscess presenting atypically as fever of unknown origin (FUO) in an elderly patient with multiple comorbidities.
- Standard initial diagnoses (pneumonia, UTI) were incorrect, underscoring the need for broader differential diagnoses in complex patients.
- Contrast-enhanced CT proved essential for definitive diagnosis when initial treatments failed.
Implications:
- Emphasizes the importance of thorough investigation of FUO in elderly patients, particularly those with renal insufficiency.
- Underscores the critical need to consider antimicrobial tissue penetration challenges when selecting treatments for prostate abscesses.
- Suggests a potential need for advanced imaging in complex cases to avoid diagnostic delays and ensure appropriate management.
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