表現為表現為攝護腺膿腫和多器官病變之類鼻疽感染

楊鎧伍¹、洪啟峰¹

嘉義基督教醫院 外科部 泌尿科¹

A case of melioidotic presenting with primary prostatic abscess and multiple organ lesions

Kai-Wu Yang¹, Chi-Feng Hung¹

Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital¹

Introduction: 

   In Southeast Asia (Thailand, Singapore, and Malaysia) and northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community-acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare. In this report, we present a case of melioidotic presenting with primary prostatic abscess and multiple organ lesions, being managed successfully after transurethral incision of prostate with bipolar system and cystostomy drainage.

Case presentation: 

  This 45-year-old male, a Thai migrant worker, presented with fever, chills, frequent urination, weakness, diarrhea, and dark stool passage for the past week. Despite receiving initial treatment for a cold, his symptoms worsened, necessitating admission to the ER. Initial laboratory tests showed pyuria and elevated C-Reactive Protein. A blood culture revealed Gram-negative bacteria, indicating bacteremia with sepsis. The patient developed respiratory distress, requiring intubation for ARDS. Chest and abdominal CT scans were performed to further investigate the infection focus, revealing bilateral pneumonia with possible septic emboli, as well as splenic and prostatic abscesses. Due to septic shock, the patient received treatment in the ICU, including IV fluids, empirical antibiotics (Doripenem plus Targocid), and vasopressors. HIV testing was negative, but the patient had a low CD4 count. Despite receiving high-dose antibiotics (Ceftazidime), Burkholderia pseudomallei persisted in blood, sputum, and urine cultures. A urologist was consulted, and a transurethral incision of the prostate and cystostomy were performed for the prostatic abscess on day 14. Post-operative complications included hemorrhage and anemia, requiring transfusion. Prostatic tissue culture confirmed Burkholderia pseudomallei. Considering poor effect of Ceftazidime, antibiotics were adjusted to Meropenem plus Doxycycline. The patient was successfully weaned off ventilation 2 days later and transferred to the ward on postoperative day 7. The infection was under control, and the patient was discharged after completing a 4-week course of antibiotic therapy.

Conclusion: 

  Burkholderia pseudomallei prostatic abscess could be one manifestation of melioidosis, with clinical symptoms potentially being subtle. Early diagnosis using computed tomography (CT) and prompt surgical drainage are crucial if antibiotic treatment is ineffective. Also, Burkholderia pseudomallei should be considered in the traveler to endemic areas with a primary prostatic abscess.