Multiloculated Prostatic Abscess Complicated by Obstructive Hydronephrosis and Epididymo-Orchitis in an Undiagnosed Diabetic Patient: A Case Report

TL;DR

A man with undiagnosed diabetes developed a severe prostate infection and related complications, highlighting the need for quick diagnosis and treatment.

Contribution

This case report highlights the rare and complex presentation of prostatic abscess in an undiagnosed diabetic patient.

Findings

A 48-year-old man presented with a multiloculated prostatic abscess, hydronephrosis, and epididymo-orchitis.

The infection was caused by MSSA and later complicated by an ESBL-producing Klebsiella pneumoniae CAUTI.

Successful treatment required transurethral drainage and targeted antibiotic therapy.

Abstract

Prostatic abscesses are rare but potentially fatal infections, particularly in immunocompromised patients such as those with uncontrolled diabetes. Complications like obstructive hydronephrosis and epididymo-orchitis are uncommon and may increase morbidity. We report the case of a 48-year-old man with no significant medical history who presented with several months of pelvic and scrotal pain. He was found to have new-onset diabetes mellitus (HbA1c >14%), and imaging revealed a 6 cm multiloculated prostatic abscess with right-sided hydroureteronephrosis and concurrent epididymo-orchitis. Initial CT-guided aspiration grew methicillin-sensitive Staphylococcus aureus (MSSA). Due to persistent infection and symptoms, the patient underwent transurethral resection and drainage. His course was further complicated by a catheter-associated urinary tract infection (CAUTI) caused by extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae, which was successfully treated with intravenous ertapenem. This case underscores the importance of prompt recognition and aggressive management of prostatic abscesses, especially in patients with undiagnosed diabetes. Imaging, surgical drainage, and targeted antibiotic therapy are crucial in preventing complications and improving outcomes.

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