Prostatitis, a rare presentation of granulomatosis with polyangiitis, successfully treated with rituximab and prednisone

Abstract

A previously healthy 21-year-old man presented with an 8-month history of weight loss, lethargy and dysuria unresponsive to empiric antibiotics and paraurethral drainage of a prostatic abscess. Urinalysis showed pyuria, but cultures failed to grow any organisms. Additionally, he developed new onset sensorineural hearing loss. CT of the chest showed two right-sided cavitary lesions. CT of the abdomen and pelvis demonstrated a prostatic abscess. A prostate biopsy demonstrated necrotising granulomatous prostatitis. A lung biopsy showed necrotising granulomatous inflammation. He was diagnosed with granulomatosis with polyangiitis (GPA). He was successfully treated with rituximab and prednisone. At 6-month follow-up, he continued to be in remission with resolution of his symptoms. This case demonstrates a rare presentation of prostatitis as the presenting symptom of GPA. As far as we know, this case is the first documented report of rituximab and prednisone as successful therapy for prostatitis secondary to GPA.

The Efficacy and Safety of Rituximab in ANCA-Associated Vasculitis: A Systematic Review

“…Following the first report of the successful treatment of AAV with RTX, different rare clinical manifestations were reported as having been successfully treated with RTX. Some of the most important rare clinical presentations in GPA patients, which resolved following RTX, include retrobulbar granuloma [ 78 ], refractory ophthalmic [ 126 ], pachymeningitis [ 146 ], the presence of orbital inflammation [ 122 ], long-established end-stage renal disease [ 147 ], post-kidney-transplantation glomerulonephritis-related AAV [ 148 ], pituitary GPA [ 149 ], renal mass [ 150 ], gastric ulcer [ 151 ], pancreatitis [ 152 ], ophthalmoplegia [ 153 ], pyoderma gangrenosum [ 154 , 155 , 156 ], prostatitis [ 157 ] aortic inflammation [ 158 ], intestinal involvement [ 159 ], mastitis [ 160 ], aortitis [ 161 ], gingivitis [ 162 ], Isolated Pauci-Immune Pulmonary Capillaritis [ 163 ], isolated orbital GPA [ 164 ], cranial neuropathy [ 165 ], severe necrotizing scleritis [ 166 ], genital necrosis and inflammation [ 167 ], GPA-associated subcutaneous cheek odule [ 168 ], pseudo-tumoral digital nodules [ 169 ], hypertrophic pachymeningitis [ 170 , 171 ], acute myocarditis [ 172 ], palpable purpura [ 173 ], central nervous system vasculitis [ 174 ], intra-cranial hypertension [ 175 , 176 ], tracheobronchial stenosis [ 142 ], acute aortic valve regurgitation [ 177 ], GPA-mimicking meningeal tuberculosis [ 178 ], gynecological involvement [ 179 ], GPA-mimicking lung mal...…”

Complex case of granulomatosis with polyangiitis involving the urethra and prostate causing outflow obstruction and ano-urethral fistula

“…Literature review does identify a clear link with GPA and prostatitis and prostatic abscess. 2,3 These cases also failed to resolve with typical supportive antimicrobial or operative treatment and did require immunosuppression to gain remission. 4 The cases similarly identify the delay in diagnosis due to the rarity of the link between GPA and inflammatory prostatitis or abscess.…”