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02 July 2022 : Case report  USA

A Case of Methicillin-Sensitive Staphylococcus aureus (MSSA) Prostate Abscess, Osteomyelitis, and Myositis Associated with MSSA Bacteremia in a 60-Year-Old Patient Presenting with Back Pain

Challenging differential diagnosis, Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Yassine Kilani1ABDEFG*, Syeda Ashna Fatima Kamal1ABEG, Ebehiwele Ebhohon1EFG, Lavina Khemani1BEG, Trisha Laxamana1BDG, Mubarak H. Yusuf1ABG, Vipul Shah1AEG

DOI: 10.12659/AJCR.936704

Am J Case Rep 2022; 23:e936704

Abstract

BACKGROUND: Staphylococcus aureus (SA) is a rare cause of prostatic abscess. Risk factors include genito-urinary instrumentalization and immunocompromised states. Because of the lack of guidelines on the diagnosis, management, and follow-up of SA prostate abscess, the diagnosis can sometimes be challenging. Our patient was a 60-year-old man who initially presented with lower back pain and was diagnosed with a methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, prostate abscess, osteomyelitis, and myositis.

CASE REPORT: A 60-year-old man presented with lower back pain. He had a past medical history of incompletely treated MSSA cervical osteomyelitis with epidural abscess, alcohol use disorder, intravenous drug use (IVDU), and poorly controlled diabetes mellitus (DM). He was afebrile and hemodynamically stable. Laboratory test results revealed leukocytosis and an elevated C reactive protein (CRP). Lumbar spine magnetic resonance imaging (MRI) showed vertebral osteomyelitis and right psoas myositis. Blood cultures isolated MSSA. The patient was treated with vancomycin and piperacillin-tazobactam. On day 5, our patient reported having fever, chills, flank pain, and dysuria. Computed tomography (CT) revealed a 4.0×4.9 cm prostatic abscess. CT-guided percutaneous abscess drainage was performed, and fluid culture revealed MSSA. Both antibiotics were discontinued and cefazolin was started following sensitivities. Post-drainage pelvic ultrasound (US) showed resolution of the abscess.

CONCLUSIONS: This case highlights the importance of a rapid diagnosis of SA prostate abscess in patients with documented risk factors and characteristic symptoms. Timely management with antibiotics and drainage as indicated are imperative to avoid further complications from the underlying bacteremia, including sepsis and metastatic infections.

Keywords: Abscess, Bacteremia, case reports, myositis, osteomyelitis, Prostate

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923