Clin Endosc.  2016 Sep;49(5):488-491. 10.5946/ce.2015.145.

Tuberculous Prostatic Abscess with Prostatorectal Fistula after Intravesical Bacillus Calmette-Guérin Immunotherapy

• Eom JH
• Yoon JH
• Lee SW
• Kim HS
• Park TY
• Bang CS
• Baik GH
• Kim DJ

• KMID: 2356059
• DOI: http://doi.org/10.5946/ce.2015.145

Abstract

Intravesical bacillus Calmette-Guérin (BCG) immunotherapy is a common treatment modality for bladder cancer after transurethral resection of a bladder tumor. This therapy is generally safe, and development of a prostatic abscess with a prostatorectal fistula after intravesical BCG immunotherapy is a very rare complication. This finding was incidentally obtained by the authors, who examined a patient with colonoscopy for evaluation of abdominal pain. The patient was successfully treated with antitubercular drugs. To the authors' knowledge, this is the first report of a patient with a tuberculous prostatic abscess with prostatorectal fistula after BCG immunotherapy in South Korea.

Keyword

Prostate; Abscess; Fistula; Tuberculosis

MeSH Terms

Abdominal Pain
Abscess*
Antitubercular Agents
Bacillus*
Colonoscopy
Fistula*
Humans
Immunotherapy*
Korea
Mycobacterium bovis
Prostate
Tuberculosis
Urinary Bladder Neoplasms
Antitubercular Agents

Figure

• 

  Fig. 1. Colonoscopic findings. (A) A small 6-mm rectal ulcer felt on the anterior wall overlying the prostate, combined with a possible fistula tract. (B) After 6 months of therapy, a persistent ulcer is visible, but its condition is improved compared to the previous condition. (C) After completion of the 9-month regimen of antitubercular therapy, the previously noted rectal ulcer disappeared.

• 

  Fig. 2. Histopathological findings. (A) Hematoxylin and eosin staining (H&E stain) shows chronic granulomatous inflammation with caseation necrosis (×200). (B) After 6 months of therapy, the biopsy still shows chronic granulomatous inflammation with caseation necrosis (×200). (C) After completion of the 9-month regimen of antitubercular therapy, the biopsy shows the disappearance of the caseation necrosis (×100).

• 

  Fig. 3. Abdominopelvic computed tomography findings. (A) An approximately 3.3-cm hypodense lesion is visible in the left prostate gland, along with adjacent mild wall thickening at the anterior wall of the distal rectum. (B) After 6 months of therapy, an approximately 2-cm hypodense lesion is visible in the left prostate gland. (C) After completion of the 9-month regimen of antitubercular therapy, the hypodense lesion in the left prostate gland disappeared.

• 

  Fig. 4. Transrectal ultrasonography findings. The procedure, which was done a month after the antitubercular therapy was initiated, shows a small hypoechoic lesion on the apical wall as well as a healed fistulous tract.

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