Trifecta of Abscesses of the Prostate, Bilateral Seminal Vesicles, and Left Epididymis Caused by Staphylococcus aureus: A Report of a Rare Case.

We report here a rare case of a concurrent occurrence of abscesses caused by Staphylococcus aureus in the prostate, seminal vesicles, and epididymis. A 71-year-old male presented to our hospital with urinary retention, and an indwelling urethral catheter was inserted. He remained afebrile until a revisit one month later when he developed a fever and left scrotal swelling. Imaging studies revealed multiple abscesses in the left lobe of the prostate, bilateral seminal vesicles, and the left epididymis. Ceftriaxone was initiated upon admission and was administered for five days before switching to cefazolin for an additional 11 days. From the sixth day of admission, levofloxacin was added to ensure adequate prostatic tissue penetration until the 18th day. Owing to his poor response to antimicrobial chemotherapy, percutaneous prostatic needle aspiration, percutaneous cystostomy, transurethral deroofing of the abscess, and left orchiectomy were performed on the eighth day. Methicillin-susceptible S. aureus was isolated from the urine and abscess fluid. The patient had no recurrence at one year postoperatively. A prostate abscess may not manifest as fever or elevated prostate-specific antigen levels, even when S. aureus is the causative agent, and can lead to delayed diagnosis and subsequent involvement of the seminal vesicles and epididymis.