Fungal prostatitis due to endemic mycoses and Cryptococcus: A multicenter case series

Abstract

BackgroundFungal prostatitis is exceedingly rare with mostly case reports.MethodsElectronic medical records at three medical centers were searched for cases of fungal prostatitis due to endemic mycoses and Cryptococcus over the preceding 10 years.ResultsSeven cases were identified from 105 600 prostate biopsies within the Southern California Permanente Medical Group for an incidence of 0.0066%. An additional eight cases were identified from two other health care systems. Excluding four patients without available clinical data, 11 patients were reviewed, most of whom underwent biopsy due to elevated prostate‐specific antigen. Four were asymptomatic and the remainder had nonspecific signs or symptoms. All biopsies revealed granulomatous inflammation and fungal organisms. Seven patients had coccidioidomycosis, three patients had cryptococcosis (confirmed in two cases and suspected by organism morphology in the other), and one patient had likely histoplasmosis based on organism morphology. Prolonged antifungal treatment was standard; outcomes were favorable.ConclusionFungal prostatitis due to endemic mycoses and Cryptococcus is uncommon and associated with favorable outcomes but generally involves prolonged therapy.

Cryptococcal Prostatitis Forming Caseous and Suppurative Granulomas Diagnosed by Needle Biopsy: A Case Report

“…16 It has also been reported that Cryptococcus infection is rarely diagnosed by a prostate biopsy. 3 Cryptococcus infection is known to develop granulomatous inflammation when the cell-mediated immunity is not impaired. 17 Although cryptococcal prostatitis is diagnosed by the presence of small encapsulated yeast cells in granulomatous lesions, especially in phagocytic cells, the small size and translucent nature of the small encapsulated yeast cells may make them difficult to find in HE-stained biopsy specimens.…”

“…However, patients with cryptococcal prostatitis were more likely to have underlying immunosuppressive conditions such as immunosuppressive agent therapy including steroids, diabetes, liver cirrhosis, hematopoietic neoplasm, and human immunodeficiency virus infection, as in this case. 3,16 Clinical information about the patient, such as immunosuppressive status and no history of BCG therapy, might be useful in diagnosing cryptococcal prostatitis by means of a biopsy.…”

“…4 Several studies have provided histologic evidence of necrosis. 3,5 However, to the best of our knowledge, no caseous granulomas (necrotizing granulomas) have been reported in cases of cryptococcal prostatitis. In addition, fungal prostatitis identified from a prostate needle biopsy is very rare.…”

“…In addition, fungal prostatitis identified from a prostate needle biopsy is very rare. 3 Here we report a case of granulomatous prostatitis caused by Cryptococcus infection in which a core needle biopsy provided various histologic findings, including a caseous granuloma as well as a suppurative granuloma.…”

“…2 Cryptococcal prostatitis is exceedingly rare and related histological findings are not well documented in the literature. 2,3 It has been reported that granulomatous prostatitis associated with Cryptococcus infection can induce the development of suppurative granulomas. 4 Several studies have provided histologic evidence of necrosis.…”