An unusual case of primary melioidotic prostatic disease: Misdiagnosed as benign prostatic hyperplasia

Melioidosis is a fatal infectious disease caused by Burkholderia pseudomallei. Its clinical manifestations are so varied that it has been called a great mimic. The primary melioidotic prostatic disease usually presents as an abscess of the prostate. This is the only documented case misdiagnosed as benign prostatic hyperplasia (BPH) because it does not show as a prostate abscess. The patient was a 66 years old male with a history of hypertension and alcoholism. Symptoms of difficulty urinating and fever had persisted for three days. Laboratory tests of the patient showed a marked increase in inflammatory markers. The first urine culture was performed to isolate Acinetobacter lwoffii, not Burkholderia pseudomallei. And CT showed prostatic hyperplasia with calcification. Thus, the preliminary diagnosis was BPH, urinary tract infection, and pulmonary infection. Cefmenoxime and Piperacillin were given for anti-infective treatment, but both of the effects were not satisfactory. Then, the second urine culture and multiple hemocultures were performed to isolate Burkholderia pseudomallei. The final diagnosis was primary melioidotic prostatic disease, BPH, pulmonary infection, bacteremia and multiple organ damage. The patient was treated with imipenem for two weeks and cured. Trimethoprim-sulfamethoxazole (TMP-SMX) was administered orally for twelve weeks after discharge. Therefore, clinicians need to have an understanding of primary melioidotic prostate disease to avoid misdiagnosis and mistreatment to improve the cure rate and survival rate of patients.