Xanthogranulomatous prostatitis presenting as Pseudomonas aeruginosa prostatic abscesses: An uncommon complication after kidney transplantation

Abstract

Xanthogranulomatous (XG) prostatitis is a rare form of granulomatous prostatitis characterized by a benign inflammatory process of non-specific etiology that clinically may mimic carcinoma. Few cases have been reported in the English language medical literature, with only four reported cases presenting as prostatic abscesses. A 70-year-old male with type 2 diabetes mellitus and two previous kidney transplants presented with septic shock secondary to Pseudomonas aeruginosa bacteremia 4 days after undergoing a cystoscopy. Despite appropriate antimicrobial therapy , P. aeruginosa persisted in the blood for a total of 7 days. There were no indwelling prosthetic devices, no complicated pyelonephritis, and no endovascular sources of infection. Upon repeat clinical assessment, the patient reported pelvic pain. A digital rectal examination revealed prostatic tenderness and an endorectal ultrasound confirmed multiple prostatic abscesses. An ultrasound-guided transrectal needle aspirate drained scant purulent fluid and cultures grew the same phenotypic strain of P. aeruginosa . For definitive source control, the patient underwent transurethral resection of the prostate with unroofing of prostatic abscesses. The pathological findings were diagnostic of XG prostatitis. Given the rather acute presentation of this case, our hypothesis is that the prior urological instrumentation likely facilitated bacterial translocation and created the ideal environment for the development of pseudomonal prostatic abscesses resulting in XG inflammation and necrosis. XG prostatitis is a rare entity of uncertain etiology that can result in prostatic abscesses, and surgery is required for definitive diagnosis and management.

Different clinical presentations of xanthogranulomatous prostatitis: A case series and review of the literature

“…Sepsis due to a prostate abscess is also a frequent mode of presentation. 7,8,10,19,20 Further, XGP is found to result in the formation of fistulae. Cases of an entero-vesical fistula 5 and a prosto-rectal fistula 18 due to XGP have been reported.…”

“…However, cases of XGP reported from temperate countries are sparse. 4,10,11,20 Thus, the possibility of an environmental factor contributing to the pathogenesis of XGP must be explored. Because of the prevalence of tuberculosis in many countries where XGP is found, it is also important to exclude tuberculous prostatitis in every case of XGP.…”

Imaging and Clinical Findings of Xanthogranulomatous Inflammatory Disease of Various Abdominal and Pelvic Organs: A Pictorial Essay

“…MRI shows T1 hypointensity and T2 hyperintensity in the bilateral peripheral zones, with peripheral enhancement and diffusion restriction ( 41 ). Prostatic abscesses are rare in patients with XG prostatitis ( 45 ). On sonography and MRI, differentiation between XG prostatitis and prostate cancer may be difficult ( 40 41 42 ).…”