攝護腺分枝桿菌感染:經尿道攝護腺刮除術後病理意外發現
劉瑞文、高偉棠
衛生福利部立雙和醫院 泌尿科
Prostate mycobacterial infection pathological finding after
transurethral resection of prostate
Liu Jui Wen, Kao Wei Tang
Department of Urology, Shuang Ho hospital, Taipei Medical University, Taipei, Taiwan
Introduction: Urinary tract mycobacterial infection is the third most common form of extrapulmonary tuberculosis infection. After literature review, many prostate infection was seen on prostate abscess culture result. It is few to be seen in prostate pathologic result. We present this case and further management.
Case report: This 72 years old male has past history of type 2 diabetes, coronary artery disease (triple vessels disease). Lung cancer was diagnosed in this year according to CT scan and biopsy result. Liver and parartracheal LN metastasis were noted. Then he was included to be the candidate of AEGEAN trial ( Neoadjuvant/ adjuvant Durvalumab for the treatment of patients with resectable non-small cell lung cancer) and accepted one dose medication of Durvalumab, Alimta and carboplatin. He denied discomfort after treatment. This time he came to our clinic for progressing lower urinary tract symptoms. IPSS score showed total 31, IIEF score showed total 12. Prostate volume was 50cc and post voiding residue amount was 29ml. PSA value showed 23.19. So operation was suggested and he accepted. Pre-operation survey showed obvious contraindication. He accepted laser enucleation transurethral resection of prostate then. Post-operation fever was noted and clinical condition was subsided gradually under antibiotic control. However, operation pathological result showed prostate adenocarcinoma Gleason grade 3+3, necrotizing granulomatous inflammation and acid-fast stain positive. After out-patient department, he was drawn out from clinical trial and accepted further mycobacterial treatment. His clinical condition was stable during follow up.
Discussion: Malignant disease immunotherapy, chemotherapy or target therapy is associated with variety of mechanism for extinguishing cancer cell. But some medication is associated with bone marrow depression, immune system impaired. This case we showing is rare tuberculosis granulomatous change of prostate instead prostate abscess. So post transurethral resection of prostate fever is need for well evaluation. Especially in this kind immunocompromised patient, we should include possibility of tuberculosis infection. His clinical presentation and following chest X ray is improving after accepts anti-tuberculosis medication.