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Prostatic abscess in a patient with ST-elevation myocardial infarction: a case report.

Kadoya Y, Kenzaka T - BMC Cardiovasc Disord (2016)

Bottom Line: We initially diagnosed catheter-associated urinary tract infection.The patient recovered remarkably after treatment without drainage or surgery.Furthermore, unnecessary invasive instrumentation should be avoided or limited to diminish the risk of infections.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Kyotambacho Hospital, Kyotambacho, Kyoto, Japan. m03020kdy@gmail.com.

ABSTRACT

Background: In patients with ST-elevation myocardial infarction (STEMI), urinary tract infection is the most common infection-related complication. Prostatic abscess in a patient with STEMI is very rare.

Case presentation: We report the case of a 49-year-old Japanese man who developed fever and shaking chills during hospitalization for STEMI. We initially diagnosed catheter-associated urinary tract infection. However, subsequent contrast-enhanced computed tomography revealed multiple large abscesses in his prostate. We decided to treat with antimicrobial agents alone because the patient was receiving dual-antiplatelet therapy and discontinuation is very high risk for in-stent thrombosis. The patient recovered remarkably after treatment without drainage or surgery.

Conclusions: Here, we described the world's first reported case of prostatic abscess in an immunocompetent patient with STEMI. Early removal of indwelling bladder catheters in patients with STEMI receiving dual-antiplatelet therapy is important to avoid development of prostatic abscess. Furthermore, unnecessary invasive instrumentation should be avoided or limited to diminish the risk of infections.

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Contrast-enhanced computed tomography scan, revealing multiple large prostatic abscesses (red arrows). In sequence from (a) to (d), the images are sliced from the head side to the foot side
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Fig3: Contrast-enhanced computed tomography scan, revealing multiple large prostatic abscesses (red arrows). In sequence from (a) to (d), the images are sliced from the head side to the foot side

Mentions: Three days after PCI, the patient developed fever and shaking chills. He had a body temperature of 39.2 °C, blood pressure of 103/68 mmHg, regular pulse rate of 103 beats/min, respiratory rate of 18 breaths/min, and oxygen saturation of 97 % (without oxygen administration). His heart and breath sounds were normal, and his abdomen was soft and flat with no tenderness. There was no skin rash, and joint findings were normal. Laboratory data at onset of fever and shaking chills are shown in Table 1. Notably, he had a white blood cell count of 13,760 cells/mm3, hemoglobin level of 12.4 g/dL, and C-reactive protein level of 8.29 mg/dL. Cardiac enzymes were still elevated due to the STEMI, but were returning toward normal. Chest radiography showed no infiltrative shadows (Fig. 2). Urinary Gram staining revealed middle-sized gram-negative rods that were phagocytized by leukocytes. We initially diagnosed catheter-associated UTI. Blood and urine cultures were performed, his indwelling bladder catheter was removed, and he was initially administered intravenous (IV) cefmetazole (1 g every 8 h). The fever was brought down temporarily, but fever developed again at 4 days after starting the antimicrobial agent. In addition, micturition and pain while urinating persisted. Blood and urine cultures were both positive for Pseudomonas aeruginosa. We suspected abscess formation, and performed contrast-enhanced computed tomography, which showed multiple large abscesses in his prostate (Fig. 3).Table 1


Prostatic abscess in a patient with ST-elevation myocardial infarction: a case report.

Kadoya Y, Kenzaka T - BMC Cardiovasc Disord (2016)

Contrast-enhanced computed tomography scan, revealing multiple large prostatic abscesses (red arrows). In sequence from (a) to (d), the images are sliced from the head side to the foot side
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4759963&req=5

Fig3: Contrast-enhanced computed tomography scan, revealing multiple large prostatic abscesses (red arrows). In sequence from (a) to (d), the images are sliced from the head side to the foot side
Mentions: Three days after PCI, the patient developed fever and shaking chills. He had a body temperature of 39.2 °C, blood pressure of 103/68 mmHg, regular pulse rate of 103 beats/min, respiratory rate of 18 breaths/min, and oxygen saturation of 97 % (without oxygen administration). His heart and breath sounds were normal, and his abdomen was soft and flat with no tenderness. There was no skin rash, and joint findings were normal. Laboratory data at onset of fever and shaking chills are shown in Table 1. Notably, he had a white blood cell count of 13,760 cells/mm3, hemoglobin level of 12.4 g/dL, and C-reactive protein level of 8.29 mg/dL. Cardiac enzymes were still elevated due to the STEMI, but were returning toward normal. Chest radiography showed no infiltrative shadows (Fig. 2). Urinary Gram staining revealed middle-sized gram-negative rods that were phagocytized by leukocytes. We initially diagnosed catheter-associated UTI. Blood and urine cultures were performed, his indwelling bladder catheter was removed, and he was initially administered intravenous (IV) cefmetazole (1 g every 8 h). The fever was brought down temporarily, but fever developed again at 4 days after starting the antimicrobial agent. In addition, micturition and pain while urinating persisted. Blood and urine cultures were both positive for Pseudomonas aeruginosa. We suspected abscess formation, and performed contrast-enhanced computed tomography, which showed multiple large abscesses in his prostate (Fig. 3).Table 1

Bottom Line: We initially diagnosed catheter-associated urinary tract infection.The patient recovered remarkably after treatment without drainage or surgery.Furthermore, unnecessary invasive instrumentation should be avoided or limited to diminish the risk of infections.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Kyotambacho Hospital, Kyotambacho, Kyoto, Japan. m03020kdy@gmail.com.

ABSTRACT

Background: In patients with ST-elevation myocardial infarction (STEMI), urinary tract infection is the most common infection-related complication. Prostatic abscess in a patient with STEMI is very rare.

Case presentation: We report the case of a 49-year-old Japanese man who developed fever and shaking chills during hospitalization for STEMI. We initially diagnosed catheter-associated urinary tract infection. However, subsequent contrast-enhanced computed tomography revealed multiple large abscesses in his prostate. We decided to treat with antimicrobial agents alone because the patient was receiving dual-antiplatelet therapy and discontinuation is very high risk for in-stent thrombosis. The patient recovered remarkably after treatment without drainage or surgery.

Conclusions: Here, we described the world's first reported case of prostatic abscess in an immunocompetent patient with STEMI. Early removal of indwelling bladder catheters in patients with STEMI receiving dual-antiplatelet therapy is important to avoid development of prostatic abscess. Furthermore, unnecessary invasive instrumentation should be avoided or limited to diminish the risk of infections.

Show MeSH
Related in: MedlinePlus