Belga Sara, Chen Will, Low Gavin, Cervera Carlos
Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
IDCases. 2019 May 10;17:e00559. doi: 10.1016/j.idcr.2019.e00559. eCollection 2019.
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 bacteremia 4 days after undergoing a cystoscopy. Despite appropriate antimicrobial therapy 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 . 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.
黄色肉芽肿性（XG）前列腺炎是一种罕见的肉芽肿性前列腺炎，其特征为非特异性病因引起的良性炎症过程，临床上可能类似癌症。英文医学文献中报道的病例很少，仅有4例报告为前列腺脓肿。一名70岁男性，患有2型糖尿病且曾接受过两次肾脏移植，在膀胱镜检查后4天因菌血症继发感染性休克。尽管进行了适当的抗菌治疗，菌血症仍在血液中持续了7天。患者没有留置假体装置，没有复杂性肾盂肾炎，也没有血管内感染源。在再次临床评估时，患者报告有盆腔疼痛。直肠指检发现前列腺压痛，经直肠超声证实有多个前列腺脓肿。超声引导下经直肠穿刺抽吸排出少量脓性液体，培养结果显示为相同表型菌株。为了进行明确的源头控制，患者接受了经尿道前列腺切除术并切开前列腺脓肿。病理结果诊断为XG前列腺炎。鉴于该病例的表现较为急性，我们的假设是，先前的泌尿外科器械操作可能促进了细菌移位，并为假单胞菌性前列腺脓肿的发展创造了理想环境，导致XG炎症和坏死。XG前列腺炎是一种病因不明的罕见疾病，可导致前列腺脓肿，手术是明确诊断和治疗所必需的。
