Can't PEE and PE: An Uncommon Combination of 2 Common Diseases in an Air Marshal

1Beth Israel Deaconess Medical Center, Boston, MA
2Beth Israel Deaconess Medical Center, Boston, MA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 177

Case Presentation:

A 38‐year‐old man with no significant medical history presented to the emergency room with inability to void, yellow urethral discharge, and fever up to 101.4°F. He reported being sexually active with 1 female partner and denied any unprotected intercourse. On physical exam he had an enlarged nontender prostate. He was given ceftriaxone and azithromycin in the emergency room. A Foley catheter was placed, and he was discharged with the Foley catheter, oral ciprofloxacin, and an outpatient urology appointment. He represented to our institution 10 days later with right‐sided chest pain that was worse with deep inspiration and improved with sitting up. The patient worked as an air marshal and traveled almost daily including transatlantic flights. Urine antigen for Neisseria gonorrhoeae and Chlamydia trachomatis from initial urine sample were negative. CT angiography of the chest revealed a filling defect in the segmental branches of the right lower lobe. CT scan of the pelvis revealed multiple low‐density collections within the prostate gland, suggestive of abscesses, and a thrombosis of the right iliac vein. The patient was continued on cipro‐floxacin for 6 weeks, the Foley was removed, and his urinary retention had resolved. He was anticoagulated for 6 months and has remained symptom free since then. The results of a hypercoaguble workup including antithrombin III, proteins C and S, factor V Leiden, and prothrombin mutation analysis were all within normal limits.

Discussion:

Signs and symptoms of acute prostatitis include fevers, chills, malaise, myalgia, dysuria, and pelvic pain. Obstructive symptoms such as urinary hesitancy and retention can occur with inflammation swelling of the prostate gland. Acute prostatitis and prostate abscess are difficult to differentiate based on clinical history. In patients with prostate abscess, enlarged prostate is found in 75% of patients, whereas fever and urinary retention are found in one third of cases. In 1856, Virchow proposed 3 precipitants for venous thrombosis: venous stasis, hypercoagubality, and vessel wall injury. Infection is thought to increase at least 2 components of this triad: venous stasis and hypercoagubality of blood. Patients are at an increased risk for deep venous thrombosis (IR 2.10, 95% CI 1.56‐2.82) and pulmonary embolism (IR 2.11, 95% CI 1.38‐3.23) in the first 2 weeks after a urinary tract infection.

Conclusions:

Although venous congestion has been observed in patients with chronic prostatitis, this is the first reported case of iliac vein thrombosis resulting in a pulmonary embolism in a patient with prostate abscess. Both prostate abscess and acute prostatitis have similar presentations, and hospitalists need to be aware that it is difficult to differentiate the 2 solely on clinical history.

Author Disclosure:

S. Shah, none; A. Carbo, none.

To cite this abstract:

Shah S, Carbo A. Can't PEE and PE: An Uncommon Combination of 2 Common Diseases in an Air Marshal. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 177. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/cant-pee-and-pe-an-uncommon-combination-of-2-common-diseases-in-an-air-marshal/. Accessed May 26, 2019.

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