從前列腺到肺部:經尿道前列腺刮除手術後意外發現之結核病伴隨直腸及肺部侵犯之病例報告

蘇劭臻、黃鐘銘、林益聖、許兆畬、歐宴泉、童敏哲

童綜合醫院 外科部 泌尿科

From prostate to pulmonary: A case of tuberculosis discovered incidentally during TURP with subsequent rectal and pulmonary involvement

Shao-Chen Su, Chung-Ming Huang, Yi-Sheng Lin, Chao-Yu Hsu, Yen-Chuan Ou, Min-Che Tung

Divisions of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan

Case presentation:

    A 72-year-old male with hypertension and diabetes presented with frequency and weak stream for several weeks. His PSA level was 7.7 ng/ml, and prostate sonography revealed an enlarged prostate (93 c.c.) with central calcification. Urine flow tests indicated obstructive uropathy (Qmax 7.6 ml/s, Qavg 3.6 ml/s). After laser prostatectomy [Figure 1], pathology unexpectedly revealed prostate tuberculosis. Shortly thereafter, he experienced persistent abdominal cramping and diarrhea, leading to a colonoscopy that found an ulcer-like lesion in the rectum [Figure 2], confirming mycobacterial infection and cytomegalovirus colitis. He was referred to an infectious disease specialist for tuberculosis evaluation. A chest CT later showed multiple small nodules with spiculated margins in the bilateral upper lungs [Figure 3], consistent with pulmonary tuberculosis. A 2-month of quadruple anti-TB treatment (Rifampin, INH, EMB, PZA) was initiated, and subsequent sputum culture confirmed pulmonary tuberculosis.

Discussion:

    Tuberculosis remains one of the most prevalent infectious diseases worldwide, with an incidence rate of 28 cases per 100,000 population in Taiwan in 2022. Urogenital tuberculosis (UG-TB) is the third most common form of extrapulmonary tuberculosis (EPTB), accounting for 30% to 40% of cases. It can affect any part of the urinary tract, with renal TB being the most frequently reported form, followed by prostate TB. Prostatic TB is thought to result from hematogenous or lymphatic spread or from local extension from adjacent organs, such as the epididymis. Due to its insidious onset and nonspecific symptoms, prostatic TB is often overlooked or misdiagnosed, leading to underreporting. In the present case, the patient experienced dysuria, urinary frequency, and weak urinary stream, symptoms that closely mimic those of benign prostatic hyperplasia. Solitary UG-TB is rare; autopsy studies have shown that 85% of patients with UG-TB also have associated pulmonary lesions. Our patient, however, presented with concurrent pulmonary, rectal, and prostate TB, highlighting the importance of considering other sources of TB infection, particularly pulmonary lesions, when prostate TB is diagnosed. A delayed diagnosis may contribute to disease progression and potentially lead to irreversible organ damage.