A Case of Tuberculous Prostatitis with Abscess
A 56-year-old man visited the Department of Urology for hematuria. A cystoscopic examination was performed and a bladder mass was found. He underwent a transurethral resection of a bladder tumor (TURBT) for a low grade T1 urothelial carcinoma. He had been treated for pulmonary tuberculosis with an anti-tuberculous agent for 6 months approximately 14 years earlier. The chest X-ray at the time of the initial visit showed an inactive pulmonary tuberculosis lesion in the right apical lung. Intravesical BCG (OncoTice®, Organon Teknika, Boxtel, Netherlands) instillations were performed once per week for 6 weeks at a concentration of 12.5 mg in 50 ml saline.\nSix months after TURBT following the completion of induction BCG therapy, the patient complained of frequency, dysuria, and perineal discomfort. A digital rectal examination (DRE) showed tenderness in the right lobe of the prostate. A computed tomography (CT) scan was performed for the evaluation of prostate infection and revealed an oval-shaped low density lesion (). The level of prostate specific antigen, which had been 0.2 ng/ml 6 months earlier, was 2.17 ng/ml. For the differential diagnosis of the prostatic oval-shaped low density lesion, a prostate biopsy was performed. The histology of the needle biopsy showed granulomatous inflammation of the prostate with caseating necrosis in the prostate specimens. A Ziehl-Neelsen stain revealed a few acid-fast bacilli (). The tuberculous prostatic abscess was confirmed. The patient was treated with a 12 month anti-tuberculous regimen of isoniazid (300 mg), rifampicin (600 mg), ethambutol (800 mg), and pyrazinamide (1,500 mg) daily. The follow-up CT showed the disappearance of the prostatic abscess () after 12 months of anti-tuberculous medication.