# A Rare Infectious Complication Following Transrectal Prostate Biopsy: Spondylodiscitis With Contiguous Psoas Muscle Abscess

## TL;DR

A rare spinal infection with a psoas abscess occurred after a prostate biopsy, highlighting the importance of early diagnosis and MRI for effective treatment.

## Contribution

This case highlights the rare but serious complication of spondylodiscitis following transrectal prostate biopsy and emphasizes the role of MRI in diagnosis.

## Key findings

- Spondylodiscitis with psoas abscess occurred 24 hours after a transrectal prostate biopsy.
- MRI was crucial for diagnosing the infection and guiding treatment.
- Empirical antibiotics were adjusted after E. coli was identified from cultures.

## Abstract

Spondylodiscitis is a rare but potentially serious spinal infection. Although Staphylococcus aureus is the most common pathogen, Escherichia coli has been increasingly associated with genitourinary procedures such as transrectal prostate biopsy, even with antibiotic prophylaxis.

We present the case of a 71-year-old man who underwent a transrectal prostate biopsy due to elevated prostate-specific antigen (PSA) levels. He developed fever and lower back pain 24 hours after the procedure. Initial studies suggested a bacterial infection, and empirical antibiotic treatment was initiated. Lumbar magnetic resonance imaging (MRI) revealed L4-L5 spondylodiscitis with left paravertebral involvement and an ipsilateral psoas abscess. Computed tomography (CT)-guided percutaneous drainage and disc biopsy were performed. Cultures isolated E. coli, allowing for adjustment of the antibiotic treatment, with a favorable clinical outcome.

Although spondylodiscitis secondary to transrectal prostate biopsy is uncommon, the presence of fever and lower back pain was key to the diagnostic suspicion. Imaging studies, particularly MRI, proved essential for establishing the diagnosis and guiding effective treatment.

Infectious spondylodiscitis is a rare but potentially fatal complication following transrectal prostate biopsy. Early clinical suspicion and prompt pathogen identification are essential. MRI and image-guided minimally invasive procedures, including percutaneous biopsy and drainage, play a key role in diagnosis and effective management.