[Visualisation of the ejaculatory tract in a patient with empyema of the seminal vesicles]

Fever and malaise without the possibility of an adequate anamnesis has a broad differential diagnosis. Under these conditions in male patients several rare urogenital disorders need to be considered.

A 26-year-old mentally disabled young man was examined because of a fever, altered behaviour and elevated infection parameters. A CT-scan of the abdomen showed signs of prostatitis. Transrectal ultrasonography was performed under general anaesthesia to rule out a prostatic abscess. This showed prominent, dilated seminal vesicles. Under transurethral sight, large amounts of pus was drained from the ejaculatory ducts by digital rectal examination (unique video). Intravenous antibiotic therapy was continued and the patient successfully recovered.

Acute bacterial prostatitis is diagnosed based on the clinical presentation of the patient. When there is fever without a focus or no recovery following antibiotic therapy, an abscess of the prostate or empyema of the seminal vesicles should be considered.