Systemic candidiasis presenting with prostatic abscess

Abstract

treated with a 500 mg (total dose) regimen of intra- Case reportvenous amphotericin B over 14 days. Convalescence was uneventful, and urine and blood cultures taken before A 68-year-old man with a medical history significant for multiple sclerosis and insulin-dependent diabetes mellitus discharge were negative. CT of the pelvis 7 days after surgery showed resolution of the abscess (Fig. 2). presented from a nursing home with fever, chills and lethargy. Vital signs included a temperature of 40°C, blood pressure of 80/50 mmHg and a heart rate of Comment 150 b.p.m. The rest of the physical examination was unremarkable except for the presence of a condom Fungal abscesses of the prostate are rare, with only three culture-proven cases caused by Candida species reported catheter draining cloudy urine. The initial white blood cell (WBC) count was 42 000/L, the serum creatinine in the English literature [1][2][3]. In one case, a patient with diabetes mellitus and an indwelling Foley catheter 15 mg/L, blood glucose 5.2 g/L and urine analysis showed >50 WBC per high power field (HPF). The had C. albicans as a sole isolate on culture of the abscess patient was admitted to the intensive care unit with a presumed diagnosis of urosepsis. He was hydrated, begun on intravenous piperacillin/tazobactam and gentamicin, and had a Foley catheter placed. Urine and blood were cultured and later yielded Candida glabrata (>105 c.f.u/mL); the initial urine culture yielded a mixed growth of Staphylococcus aureus (0.5-0.75×105 c.f.u./ mL) and Streptococcus viridans (>105 c.f.u./mL). One month before presentation the patient developed a UTI from S. aureus (>105 c.f.u./mL). Then he presented with a fever of 38.3°C and had >20 WBC/HPF on urine analysis. He was treated with a 14-day course of cephalexin and the fever subsided; a repeat urine culture biotics and hydration, becoming haemodynamically stable with an associated reduction in WBC count. However, he continued to have daily temperature increases to 39.5-40°C. CT of the abdomen and pelvis showed a well-defined area of low attenuation, primarily involving the right lobe of the prostate (Fig. 1). A DRE then detected an enlarged, boggy and slightly tender gland. TRUS confirmed the presence of a well-defined hypoechoic area within the capsule of the prostate, consistent with the presumed diagnosis of prostatic abscess. The patient underwent TURP and the prostatic abscess was unroofed; #25 mL of purulent material was expressed from the abscess and sent for culture. A 24 F Foley catheter was left indwelling. Intraoperative cultures on Sabouraud agar yielded C. glabrata. The patient was 450

Prostatic Abscess due to <i>Candida</i> with No Systemic Manifestations

“…Major risk factors are immunosuppression, steroid therapy, long-term antibiotic therapy, urinary flow disorders, indwelling catheters, congenital abnormalities of the urinary tract and neurogenic bladder [5]. However, the prostate gland is rarely involved due to the effective treatment of fungus-related urinary infections and the antifungal properties of prostatic fluid [1]. Risk factors for prostatic abscess include bladder outlet obstruction, previous urinary infections and immunosuppression.…”

“…Prostatic abscess due to fungi is usually secondary to systemic infections [1,7], with patients presenting marked general symptoms. However, the clinical findings of isolated prostatic abscess are nonspecific and may be confused with those of bacteria-related abscess.…”

“…The approach may be either transrectal [6] or perineal [8,9], depending on the technical means available at each center, with a 83% resolution rate [6]. Some authors perform a transurethral prostate resection to treat the abscess and the concomitant bladder outlet obstruction [1,4]. C. albicans [3,4], Candida glabrata [1], Candida tropicalis [2] and Blastomyces dermatitidis [7] have been found in the aspirate culture.…”

“…Some authors perform a transurethral prostate resection to treat the abscess and the concomitant bladder outlet obstruction [1,4]. C. albicans [3,4], Candida glabrata [1], Candida tropicalis [2] and Blastomyces dermatitidis [7] have been found in the aspirate culture. Endovenous amphotericin B should be given to patients with systemic disease [3,7].…”

“…Prostatic abscess due to fungi is a rare condition that is secondary to systemic disease in immunosuppressed patients [1,2]. In exceptional cases it occurs as an isolated prostatic disease [3].…”