Tuberculous prostatic abscess following intravesical bacillus Calmette-Guérin immunotherapy

摘要

A 57-year-old man was diagnosed with bladder cancer and underwent bladder tumor transurethral resection to treat a high-grade T1 urothlial carcinoma. Intravesical bacillus Calmette-Guérin (BCG) (BCG for Therapeutic Use, CDIBP, China) immunotherapy was performed once per week for 6 weeks at a concentration of 120 mg in 50 mL saline. The patient had no history of tuberculosis. After 6 weeks of treatment, the patient complained of perineal discomfort. A digital rectal examination (DRE) showed tenderness, thus resulting in suspicion of infection in the left lobe of the prostate. Microscopic urinalysis showed few red blood cells. The level of total prostate-specific antigen (PSA) was 2.61 ng/mL, and the free PSA was 0.23 ng/mL. A magnetic resonance (MR) scan was performed to evaluate prostate infection and revealed an approximately 2.1 × 1.2 cm hypo-intense lesion on T2-weighted imaging (T2WI) and hyper-intensity on diffusion-weighted imaging in the peripheral zone of the left prostate gland [Figure A and 1B]. For differential diagnosis of the prostatic hypo-intense lesion on T2WI, a prostate biopsy was performed. Subsequent histology showed granulomatous prostatitis [Figure C] positive for tuberculosis according to polymerase chain reaction. There was no evidence of tuberculosis elsewhere. On the basis of these findings, tuberculous prostatic abscess was confirmed. The patient was treated with a 9-month anti-tuberculous regime of isoniazid (300 mg/day), rifampicin (450 mg/day), and ethambutol (750 mg/day). The symptoms were relieved after 1 month of anti-tuberculous therapy. After completion of the 9-month regimen of anti-tuberculous therapy, a follow-up MR scan was performed, which indicated disappearance of the prostatic abscess. The most recent cystoscopy showed no evidence of tumor recurrence and no inflammation of the prostate.