A case of prostatitis due to Burkholderia pseudomallei

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Abstract

Background A 67-year-old male, with a history of stable lower urinary tract symptoms, diabetes mellitus, benign prostatic hyperplasia, gonococcal urethritis, and excessive alcohol consumption, presented to the emergency room with sepsis and acute bacterial prostatitis. He had recently returned from a visit to Indonesia, where he had been a first-hand witness to the 2004 tsunami.

Investigations Complete blood cell count, urine analysis, blood, urine, and prostatic abscess cultures, chest X-ray, contrasted CT of the abdomen and pelvis, and 18F-fluorodeoxyglucose PET.

Diagnosis Melioidosis.

Management Broad-spectrum empiric antibiotics were administered initially; therapy was then changed to intravenous imipenem plus cilastatin with slow initial clinical improvement. 18F-fluorodeoxyglucose PET localized the prostate as the only nidus of infection. Ultrasound-guided fine needle aspiration of a small fluid collection of the prostate also grew Burkholderia pseudomallei. The patient improved clinically and was discharged to complete a 2-week course of intravenous imipenem plus cilastatin followed by a 3-month course of oral trimethoprim plus sulfamethoxazole. This medication was switched to co-amoxiclav and doxycycline to complete the 3-month course. The patient was well at his last follow-up, 3 months following hospital discharge.

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Figure 1: CT scan revealing the patient's enlarged, heterogenous prostate with nonenhancing fluid collections.
Figure 2: 18F-fluorodeoxyglucose PET scan showing the patient's increased prostatic uptake, which signals residual infection and a possible abscess.
Figure 3: Sputum gram stain from a patient with pulmonary melioidosis.
Figure 4: Burkholderia pseudomallei colonies on MacConkey agar.

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Acknowledgements

The authors would like to thank Dr Gary Lum of the Northern Territory Government Pathology Service, Australia for the photographs, and Dr Clinton Murray of the Infectious Disease Service, Brooke Army Medical Center for his assistance with the manuscript.

The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the US government. The authors are employees of the US government, and this article was written as part of their official duties; therefore, no copyright is claimed.

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Correspondence to Jorge M Arzola.

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The authors declare no competing financial interests.

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Arzola, J., Hawley, J., Oakman, C. et al. A case of prostatitis due to Burkholderia pseudomallei. Nat Rev Urol 4, 111–114 (2007) doi:10.1038/ncpuro0713

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