BJU International 2001 88 (cr7), 803CASE REPORTS
Seminal vesicle abscess caused by Mycobacterium tuberculosis
Department of Urology, Avicenne Hospital, University of Rabat, Morocco
Comment References Authors
A 42-year-old man presented in August 1997 with a 3-month history of orchiditis (managed by fluoroquinolone), rectal tenesmus, perineal and rectal pain, and loss of weight (5 kg in 2 months). Rectal palpation showed a mass of 6 cm, situated 8 cm from the anal margin. Laboratory evaluation showed microcytic anaemia, a negative evaluation for HIV and positive for fecal parasites. Urine and saliva culture for Mycobacterium tuberculosis was negative. TRUS showed a thin mass of 33 × 16 mm with heterogeneous areas suggesting abscess formation (Fig. 1). CT of the pelvis showed a hypertrophic right seminal vesicle, containing hypodense liquid with contrast material enhancement in the wall. The prostate was moderately heterogeneous with a hypodense zone (Fig. 2). A transrectal puncture under TRUS guidance obtained a purulent material that showed nothing on culture. Because there was no improvement with antibiotic therapy and no causal diagnosis, the seminal vesicle was removed surgically via a transvesical approach. The histological findings of the tissue showed tubercules with caseous necrosis (Fig. 3). Antituberculous medication, consisting of rifampicin, isoniazid and ethambutolal hydrochloride, was given daily for 9 months, providing complete resolution, and the patient was asymptomatic after 2 years of follow-up.
Case report References Authors
A seminal vesicle abscess is an extremely rare manifestation of genitourinary tuberculosis [1,2]; to our knowledge, until 1999, only 12 cases had been reported. Escherichia coli was responsible in seven cases, Staphylococcus aureus in two, M. tuberculosis in two and one case was unspecified [1,3,4]. The present patient is the third with a seminal vesicle abscess caused by M. tuberculosis. He presented with perineal pain but with no irritative or obstructive voiding symptoms. The DRE remains the initial evaluation leading to the suspicion of an abscess in the prostate or seminal vesicle, as reported in six of the 12 previous cases and in the present. A rectal examination, rectal ultrasonography and CT can confirm the diagnosis . Kang et al. described characteristic CT findings in patients with seminal vesicle abscess, including seminal vesicle enlargement with hypodense areas within the gland, adjacent perivesical inflammation, and associated bladder wall thickening; these findings were also present in our patient. A causal diagnosis of genitourinary tuberculosis is based on the culture of purulent material, a histological examination using acid-fast stain, or culture of tissue specimens [1,4]. The aim of transperineal needle puncture under TRUS guidance used in the present patient was therapeutic and diagnostic, but the abscess fluid was negative for M. tuberculosis. The diagnosis was confirmed only after a histological evaluation of the affected tissue. The use of fluoroquinolones by the present patient might explain this result; indeed, the increased use of fluoroquinolones in treating urinary infection may impair the ability to diagnose tuberculosis by suppressing its growth in culture. Patients taking fluoroquinolones may require a more extensive evaluation, including histology and culture from tissue specimens .
Case report Comment Authors
Case report Comment
A. Benchekroun, Professor.
M. Alami, Resident of Urology.
M. Ghadouane, Resident of Urology.
Z. Belahnech, Professor.
M. Faik, Professor.
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|To cite this article|
|Benchekroun, A., Alami, M., Ghadouane, M., Belahnech, Z. & Faik, M. Seminal vesicle abscess caused by Mycobacterium tuberculosis.
BJU International 2001 88 (cr7), 803
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|Correspondence: A. Benchekroun, Department of Urology, Avicenne Hospital, University of Rabat, Morocco. |