Methicillin-Sensitive Staphylococcus Aureus Bacteremia Secondary to a Prostate Abscess in Healthy 19-Year-Old Male

Case Report

Austin J Clin Case Rep. 2014;1(2): 1010.

Methicillin-Sensitive Staphylococcus Aureus Bacteremia Secondary to a Prostate Abscess in Healthy 19-Year-Old Male

Sangarlangkarn A1 and Villanueva MS2*

1Department of Medicine, Mt. Sinai School of Medicine, USA

2Department of Medicine, Yale University School of Medicine, USA

*Corresponding author: Villanueva MS, Department of Medicine, Section of Infectious Disease, Yale University School of Medicine,135 College St., Suite 323, New Haven, CT, 06511, USA

Received: May 30, 2014; Accepted: June 12, 2014; Published: June 14, 2014


Prostate abscess caused by Staphylococcus Aureus is rare and is infrequently reported as a cause of persistent bacteremia. Previous reports were predominantly due to Methicillin-resistant Staph aureus, occurring in patients with diabetes, prolonged indwelling urinary catheters, instrumentation or trauma to the lower urinary tract. We report an unusual case of a healthy 19-year-old male with persistent Methicillin-sensitive Staphylococcus aureus bacteremia and septic pulmonary emboli from a prostate abscess in the absence of obvious risk factors.

Keywords: Staph aureus bacteremia; Prostate abscess; Methicillin sensitive Staph aureus; Methicillin resistant Staph aureus

Case Presentation

A 19-year-old male presented with 3 days of fever, headache and abdominal discomfort accompanied by pain and tingling in his scrotum while voiding. Past medical history included brain arteriovenous malformation status post gamma knife. He underwent bilateral hydrocele/inguinal hernia repair as a child. He had no history of diabetes, intravenous drug use or immunodeficiency. He had intermittent facial acne and furunculosis. He was sexually active but denied anal intercourse; he had no history of Sexually Transmitted Infections (STIs). He denied recent digital rectal exam or trauma to the genital area; he was an avid bicyclist but had no recent prolonged bike rides. There was no history of urinary problems. He was a nursing student.

On admission, temperature was 103.3; blood pressure 120/70, heart rate 118, respiratory rate 26 and oxygen saturation 96% on room air. On physical exam, lungs were clear and cardiac exam showed no murmur. The abdomen was soft and non-tender; digital rectal exam was not performed. The scrotum was mildly tender to palpation. Laboratory testing on admission showed white blood count of 18.6cells/mm3. Urinalysis revealed positive leukocyte esterase along with 20-30 white blood cells and 10-20 red blood cells per high-power field. Chest radiograph was normal.

Admission blood and urine cultures were positive for Staphylococcus Aureus susceptible to Oxacillin (MSSA).The patient was started on intravenous Oxacillin. On hospital day 2, he developed pleuritic chest pain. Chest radiograph showed new non-cavitating nodular opacities in both lower lobes. Transesophageal echocardiogram revealed no valvular vegetations. Renal ultrasound revealed no focal lesions. HIV testing was negative. Urine testing for gonorrhea and chlamydia was negative. Because of persistent fevers and bacteremia after 48 hours on appropriate antibiotics, computer tomography of the chest/abdomen/pelvis with intravenous contrast was performed; this showed scattered bilateral pulmonary nodules and a 4 x 2.5 cm tubular cystic structure in the prostate gland suggestive of prostate abscess with reactive left common iliac lymph node (Figure 1). He underwent cystoscopy and transurethral uprooting of the abscess. Cultures from the abscess grew MSSA with the same antibiotic susceptibilities as the blood culture isolate. Pathology revealed acute or chronic inflammation. Post-operatively, the fevers resolved. He was discharged home and completed 4 weeks of intravenous Oxacillin. Eight months later, an abdominal pelvic MRI scan showed resolution of the abscess.

Citation: Sangarlangkarn A and Villanueva MS. Methicillin-Sensitive Staphylococcus Aureus Bacteremia Secondary to a Prostate Abscess in Healthy 19-Year-Old Male. Austin J Clin Case Rep. 2014;1(2): 1010. ISSN 2381-912X