Infect Chemother.  2011 Feb;43(1):64-67. 10.3947/ic.2011.43.1.64.

Emphysematous prostatitis combined with a liver abscess caused by Klebsiella pneumoniae

• Kim JY
• Ahn KR
• Han SW
• Baek HR
• Lee EJ
• Lee CB
• Kim ES

• KMID: 2170336
• DOI: http://doi.org/10.3947/ic.2011.43.1.64

Abstract

Emphysematous prostatitis is a rare condition that is characterized by gas and abscess accumulation in the prostate. This uncommon but serious disease requires special attention because of its nonspecific presentation such as dysuria, frequency, urgency, fever, acute urinary retension and/or perineal pain. We report here on a case of emphysematous prostatitis that was combined with a liver abscess caused by Klebsiella pneumoniae. A 55-year-old man was admitted due to a 3-day history of urinary retention with a febrile sensation. He had histories of liver cirrhosis and uncontrolled diabetes mellitus. After blood and urine cultures, levofloxacin 500 mg was started intravenously. On the third hospital day, he displayed septic shock. The kidneys-ureters bladder (KUB) X-ray showed pockets of air-accumulation in the lower pelvic cavity, and abdominopelvic computed tomography (CT) with contrast enhancement taken on the third day showed a 5-cm liver abscess with an emphysematous prostate. Intravenous antibiotics was changed to metronidazole 500 mg q.i.d. and cefotaxime 2 g t.i.d. On the sixth day, transurethral resection and drainage were performed under spinal anesthesia. However, the postoperative bleeding continued and hypovolemic shock persisted, which then provoked multiorgan failure. The patient died on the 11th hospital day. K. pneumoniae was cultured from the liver abscess aspirate, blood and prostatic tissue, and the bacteria were sensitive to both levofloxacin and cefotaxime. Emphysematous prostatitis is a difficult to diagnose because of its rarity and nonspecific symptoms. A delayed diagnosis can cause high mortality and morbidity, so making a prompt clinical diagnosis of this condition is essential. Appropriate antibiotics with early adequate incision and drainage are also needed.

Keyword

Klebsiella pneumoniae; Liver abscess; Prostatitis

MeSH Terms

Abscess
Anesthesia, Spinal
Anti-Bacterial Agents
Bacteria
Cefotaxime
Delayed Diagnosis
Diabetes Mellitus
Drainage
Dysuria
Fever
Hemorrhage
Humans
Klebsiella
Klebsiella pneumoniae
Liver
Liver Abscess
Liver Cirrhosis
Metronidazole
Middle Aged
Ofloxacin
Pneumonia
Prostate
Prostatitis
Sensation
Shock
Shock, Septic
Urinary Bladder
Urinary Retention
Anti-Bacterial Agents
Cefotaxime
Metronidazole
Ofloxacin

Figure

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  Figure 1 Initialcomputed tomography (CT) with contrast enhancement shows one abscess at segment V of the liver and a normal prostate.

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  Figure 2 The kidney-ureters bladder (KUB) X-ray taken after CT scan showed accumulated air pockets (arrow) in the lower pelvic cavity suggesting emphysematous prostatitis. This image was taken on the third hospital day.

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  Figure 3 The CT scan with dynamic contrast enhancement shows about a 5 cm sized hepatic abscess at segment V of the liver and an emphysematous prostate. This image was taken on the third hospital day.

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  Figure 4 The histopathology shows necrotic change and many neutrophils infiltrating the prostatic tissue (H & E stain, ×100).

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