陳世亮、張廷瑞、許智凱

台南市立醫院 泌尿科

Shih-Liang Chen, Ting-Jui Chang, Chih-Kai Hsu

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Background: Prostate abscess is an uncommon disease, mostly in patient with recurrent urinary tract infection, chronic bacterial prostatitis, in patient with diabetes or immuno-suppressed status. The common infecting organism is the Gram negative bacteria, such as E. coli. We reported a case of prostate abscess infected by Burkholderia Pseudomallei, that rarely seen Taiwan, with no risk factors and bacteria contact history.

Case Report: A 56 years-old man without diabetes and other medical history. Suffered from acute urinary retention, transrectal ultrasound showed an enlarged prostate around 52mL and elevated PSA: 55.08ng/ . Urine routine was normal , and no symptoms of infection was observed. Self voiding recovered after catheterization and medical treatment. But AUR again with fever was noted 2 weeks later and he came to ER for help. LAB data showed leukocytosis, but no pyuria was noted.  PSA also in the normal limit: 1.48. He was admitted under FUO and urine retention. After series of study, only prostate abscess was suspected as the infection source of fever. Blood culture and urine culture all showed negative result. Due to the infectious status and urinary retention, surgical intervention was suggest. Transrectal ultrasound guided needle aspiration and TURP was performed simultaneously. The bacteria cultured from the aspirated pus is Burkholderia Pseudomallei. Due to total necrosis of prostate stroma was noted, Foley was kept till 4th week. Patient voided well after Foley removed and infection was totally resolved

Discussion:. Prostatic abscess is an uncommon condition, often difficult to discern clinically from acute prostatitis. Historically, the common infecting organisms were Neisseria gonorrheae, Staphylococcus aureus and Mycobacterium tuberculosis. However, more recently, gram negative bacteria, such as Escherichia coli, are causative species. Prostatic abscess mainly affects diabetic and immunosuppressed patients. In our case, the rarity of pathogen and infected in a quite healthy man. Burkholderia pseudomallei is a Gram-negative, bipolar, aerobic, motile rod-shaped bacterium. It existed in water and soil of tropical zones, from southeast Asia to north of Australia. People can be infected through an open wound or ingested the contaminated water or soil, and cause melioidosis. Only few cases had been reported in Taiwan, and mostly causing skin or lung infection, few progressed to blood stream infection. 81 cases of prostate abscess due to Burkholderia pseudomallei, have been reported in Australia, but none in Taiwan. In our case, patient recovery well after adequate surgical drainage and antibiotic treatment.