Staphylococcus aureus prostatic abscess in a young diabetic patient: a case report and literature review.

INTRODUCTION: Prostatic abscess is a rare complication of acute bacterial prostatitis, accounting for approximately 0.5% of urologic conditions. It is mostly caused by gram-negative organisms such as Escherichia coli, although Staphylococcus aureus is an increasingly recognized but uncommon pathogen. Clinical presentation is often non-specific with lower urinary tract symptoms, frequently leading to delayed diagnosis. Imaging plays a crucial role in confirming the diagnosis and guiding management.

CASE PRESENTATION: A 41-year-old diabetic man who initially presented with lower urinary tract symptoms for 1 week that progressed to urinary retention and fever. Was initially diagnosed with acute prostatitis and initiated on intravenous ceftriaxone sulbactam with no improvement. Imaging with pelvic MRI confirmed a prostatic abscess, and cultures isolated S. aureus. The patient was managed with targeted antimicrobial therapy and transrectal ultrasound-guided aspiration, resulting in favorable clinical improvement.

CONCLUSION: Prostatic abscess should be considered in patients with persistent symptoms despite treatment for acute prostatitis, particularly in high-risk individuals. This case underscores the need to consider this diagnosis in patients with persistent or worsening symptoms despite appropriate initial therapy. Early imaging, recognition of atypical pathogens such as S. aureus, and prompt culture-directed antibiotics with minimally invasive drainage are essential for optimal outcomes.