Letter to the Editor

Methicillin-Resistant Staphylococcus aureus: Fatal Prostatic Abscess in an AIDS Patient

Authors: Mamatha Gautam, MD, Anurag Gandhi, MD, Fredrick Rose, MD

Abstract

To the Editor:


A 51-year-old male presented with a history of fever, dysuria, and suprapubic pain for 1 week. The patient had not been sexually active for the last 4 years. His medical history was unremarkable, and he denied any ongoing IV drug abuse (IVDA). On rectal examination there was exquisite pain on palpation of the prostate, but no fluctuation was noted. Urine analysis was negative for white blood cells, white cell casts, and nitrite. Computed tomography of the pelvis showed an enlarged prostate with multiple low echogenic areas suggestive of an abscess (Fig.). This was drained by a transurethral approach. Blood cultures and purulent prostatic fluid grew methicillin-resistant Staphylococcus aureus (MRSA). The sensitivities were consistent with community-acquired MRSA. IV vancomycin was initiated. The patient tested positive for human immunodeficiency virus (HIV) with a CD4 count of 135. His hospital course was complicated by sepsis, adult respiratory distress syndrome, and renal failure. Trimethoprim/sulfamethoxazole and ciprofloxacin were added based on sensitivities; however, despite aggressive care in the intensive care unit, the patient expired.

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