Prostatic Abscess in a Diabetic Patient
By Tamara Halaweh, MD, & Ashish Panchal, MD
A 53-year-old man with fair control of his diabetes presented with three-and-a-half weeks of scrotal pain. He reported difficulty sitting, and complained of significant dysuria and inability to initiate a urine stream. He was also constipated, but had no fevers or chills.
A rectal exam was consistent with an exquisitely tender and boggy prostate and significant perineal tenderness. His labs were consistent with a leukocytosis of 20,000. A CT scan with rectal contrast displayed a prostate abscess measuring 5.6 x 6.2 x 6.1 cm in maximum dimensions with extension into the puborectalis sling.
The patient was given intravenous antibiotics, and had a drain placed by Interventional Radiology transrectally. A total of 120 mL of purulent fluid was aspirated before a 10-French pigtail catheter was inserted using real-time ultrasound guidance. Culture of the aspirate grew methicillin-resistant Staphylococcus aureus (MRSA). The patient received broad-spectrum antibiotic treatment with Zosyn and ciprofloxacin in the hospital, and he did well after a month course of doxycycline. He was admitted two weeks later to the hospital for hyperglycemia and had a repeat CT at that time, which showed resolution of his prostatic abscess, and his perirectal drain was removed.
Prostatitis is a common presentation for emergency physicians, and a large prostate abscess was quite an unexpected finding in this patient with almost a month of sy...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
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