A 50‐years‐old diabetic man presented with cough, fever, weight loss, malaise, and diffuse abdominal pain of 2 weeks’ duration. He denied dysuria, recent hospitalization, sick contacts, or visits to any long‐term care facility. On admission, he had a high‐grade fever and leu‐kocytosis. Physical exam was normal except for crackles in the left lung. Computed Tomography (CT) of chest showed peripheral ground‐glass opacities in the left lung suspicious of septic emboli. His blood and urine cultures both grew methicillin‐resistant Staphylococcus aureus (MRSA), and he was started on intravenous (IV) vancomycin. Because of his complaint of diffuse abdominal pain, he underwent a CT scan of the abdomen and pelvis that revealed an enlarged heterogeneous prostate with multiple ring‐enhancing cystic lesions, the largest measuring 2.3 × 2.5 × 3.5 cm, and bladder wall thickening. The largest prostatic abscess was drained under CT guidance, the pus of which grew MRSA. Transesophageal echocardiography (TEE) done after 2 weeks of antibiotic treatment did not show any vegetations. Repeat CT of the chest and abdomen/pelvis showed a decrease in the size and number of prostatic abscesses and pulmonary opacities. Despite being treated with vancomycin for 3 weeks, the patient continued to spike fevers intermittently, although repeat blood cultures remained negative. Vancomycin was changed to daptomycin, after which the patient remained afebrile. He was discharged on an intravenous home infusion of daptomycin for 6 weeks.
Even though Staphylococcus aureus is known to cause deep‐seated and occult abscesses, community‐acquired (CA)–MRSA prostatic abscess is a very rare entity, with only 3 published cases in the literature. Interestingly unlike our patient, all the patients in these cases had specific signs and symptoms of prostatic abscess such as dysuria, pelvic pain, or tender prostate. However, it is not unusual for prostatic abscess to present with nonspecific symptoms of abdominal pain, malaise, and weight loss. Diabetes mellitus and other immunosuppressive states are important risk factors for developing prostatic abscess. In addition, our patient had clinical signs of right‐sided endocarditis, with discrete pulmonary opacities that shrank with antibiotic treatment even though TEE failed to reveal vegetation. TEE can be negative in the setting of possible infectious endocarditis in 10%–15% of the cases, and the negative predictive value of TEE further decreases if an initial study is performed after a few weeks of antibiotic treatment.
Our case is reportedly the fourth case of prostatic abscess caused by CA‐MRSA. Prostatic abscesses are most commonly caused by gram‐negative bacteria such as Escherichia coli. Other, less common organisms include Pseudomonas sp., Staphylococcus sp., and obligate anaerobic bacteria. Optimum management includes drainage of the abscess and appropriate antibiotic use.
I. Javeed ‐ Drexel University College of Medicine/Hahnemann University Hospital, Medical School; P. Kaushik ‐ Drexel University College of Medicine/ Hahnemann University Hospital, employment; M. Chowdhury ‐ Drexel University College of Medicine/Hahnemann University Hospital, employment; B. Palermo ‐ Drexel University College of Medicine/Hahnemann University Hospital, employment.
To cite this abstract:Javeed I, Kaushik P, Chowdhury M, Palermo B. Community‐Acquired Methicillin‐Resistant Staphylococcus Aureus Prostatic Abscess. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 305. https://www.shmabstracts.com/abstract/communityacquired-methicillinresistant-staphylococcus-aureus-prostatic-abscess/. Accessed February 16, 2019.