Community acquired methicillin resistant staphylococcus aureus (CA-MRSA) prostatic abscess in a diabetic patient

Abstract

Prostatic abscess caused by community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is very rare with very few previously reported cases. We present here another such case where the signs and symptoms of the patient are markedly different than previously reported cases. A 50-years-old man with diabetes presented to the hospital with cough, fever, general malaise, weight loss, and diffuse abdominal pain. On admission, he was found to have a high grade fever, crackles in left lung, right lower quadrant abdominal pain, and leukocytosis. He was empirically started on levofloxacin and vancomycin. Computed tomography (CT) of the chest showed peripheral ground-glass opacities in the left lung suspicious of septic emboli. His blood and urine cultures both grew MRSA. CT scan of the abdomen and pelvis was done due to his complaint of abdominal pain that showed an enlarged prostate with multiple prostatic abscesses. The largest prostatic abscess was drained under CT guidance, which also grew MRSA. Repeat CT of the abdomen/pelvis and chest after three weeks of treatment showed a decrease in the size and number of prostatic abscesses and pulmonary opacities. Genetic analysis of the isolate was consistent with a CA-MRSA strain. The clinical presentation of our case markedly differs from previously reported cases, as our patient had no signs and symptoms of dysuria, perineal pain, or urinary hesitancy. Also unlike the other cases, we confirmed the identity of MRSA isolate as USA 300 strain, which is the dominant strain of CA-MRSA in the United States. Proper management of prostatic abscess includes drainage as well as appropriate antibiotic therapy.