Persistent Epididymitis Due to Bacteroides Fragilis After Biopsy Of

Home , Epididymis, Epididymitis, Prostate, Prostatitis

1 . 2004;63: Northport NY in consultation Northport, NY Northport, NY 773. — – Stony Brook, NY Stony Brook, NY, .NewYork:Humana Zeena Lobo, MD Urology 108. George Psevdos, MD – Maymonah Belal, MD 168. [email protected] – 141. Monica Mcgee, MS, MT Urological Men's Health: to the procedure site, which – ransrectal prostatic biopsies. Department of Microbiology Stony Brook Medical Center . 2015;61:770 — ibiotic therapies without clinical Veterans Affairs Medical Center herapy-resistant epididymitis, an- 61. – . 2008;35:101 . 1998;21:163 . 2004;11:133 REFERENCES Clin Infect Dis Stony Brook University School of Medicine . 1980;124:60 Int J Urol Int J Androl can be considered for both aerobic/anaerobic cul- 187. – — JUrol Urol Clin North Am Empiric anaerobic antibiotic coverage should also be con- DITOR 308. – 7,8 The authors have no funding or conflicts of interest to disclose. E chronic prostatitis. pain and epididymitis. In: Shoskes DA, ed. A Guide for Urologists and Primary Care Physicians aspiration cultures in the management of selectedepididymitis. patients with acute Press; 2012:181 epididymitis. Diseases Treatment Guidelines. Epididymitis. June 2014. Accessed Available May at: 20,https://www.cdc.gov/std/tg2015/epididymitis.htm. 2020. ultrasound-guided needle biopsy of prostate gland. anaerobic bacteria. 306 Division of Infectious Diseases Veterans Affairs Medical Center Division of Infectious Diseases Veterans Affairs Medical Center tures. is often isolated from rectal abscesses then spread to the epididymis.mitis The with patient appropriate was empiric treatedresponse. ant for In epididy- these rare cases of t aerobic bacteria should be consideredtion as of possible semen etiology. specimen Collec- with or a epididymal urologist aspiration sidered in cases of epididymitis after t 6. Szoke I, Torok E, Rosa E, et al. The possible role of7. anaerobic bacteria Benson in JS, Levine LA. Evaluation and therapy of chronic scrotal content 8. Berger RE, Holmes KK, Mayo ME, et al. The clinical use of epididymal 1. Taylor SN. Epididymitis. 2. Tracy CR, Steers WD, Costabile R. Diagnosis and management of 3. Centers for Disease Control and Prevention. 2015 Sexually Transmitted 4. Donzella JG, Merrick GS, Lindert DJ, et al. Epididymitis after transrectal 5. Brook I. Urinary tract and genito-urinary suppurative infections due to 5 — spe- We theorize Bacteroides B. fragilis 6 ETTER TO THE , and creatinine Bacteroides 3 L Bacteroides Bacteroides fragilis. and Enterobactereciae, like 1 Volume 00, Number 00, Month 2020 www.infectdis.com atic biopsy revealed prostatic • pectively, with minimal relief. Obligate anaerobic microorganisms are 3 Bacteroides urealyticus Infections due to anaerobic bacteria of the 4 After Biopsy of the Prostate Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is and other coliforms, are the most common path- in their cohort of 50 patients with chronic prostatitis Appropriate antibiotic therapy must empirically pro- 6 2

that did not respond to standard care of therapy and ulti- fragilis Prostatic biopsies can rarely lead to chronic prostatitis and A 72-year-old man presented to our institution complaining

Persistent Epididymitis Due to nfectious and noninfectious etiologies account for epididymitis. In older men, bacteriuria caused by prostatic hypertrophy, urethral cies. In their review, the isolationology of of these therapy-resistant bacteria was chronic likely bacterial the prostatitis. eti- Escherichia coli ogens implicated in35 infectious years. epididymitis in men older than vide coverage of these organisms. Thetrol Centers and for Prevention Disease Con- (CDC)as guidelines the consider first-line fluroquinolones agents. that the transrectal prostaticwhich biopsy colonizes likely the introduced gastrointestinal tract including the rectum and genitourinary tract have been described, like periurethralprostatic abscess, abscess, urethritis, cystitis, but not of the epididymis. 1.2 mg/dL. The urinalysis showedurine negative culture leukocyte showed less esterase than and 1000(Fig. CFU/mL. 1) A demonstrated scrotal marked ultrasound leftin the acute tail epididymitis of the with epididymis and phlegmon thickeningtal of the wall. left anterior A scro- trialincreasing of pain ertapenem and was swelling, started.Histological the Because examination patient of revealed underwent evidence persistent of an and acutedidymitis orchiectomy. and (Fig. chronic 2). epi- Tissue cultureSpeciation grew moderate was confirmed byof-flight matrix-assisted mass laser spectrometry. desorption Thefor minimum time- metronidazole inhibitory was concentration 8short mg/L or postoperative course less. The ofwithout patient cefpodoxime any completed with postsurgical a metronidazole complications. epididymitis (1%). reported 93 anaerobes cultured fromwith expressed 13 prostatic isolates secretions, being Infectious Diseases in Clinical Practice Szoke et al To the Editor: instrumentation, and urologiccan surgery all lead including to prostatic infection of biopsy the epididymis. not commonly reported asWe potential report pathogens the for first epididymitis. case of acute epididymitis due to

fragilis mately required surgical scrotal exploration and orchiectomy. of progressively worsening swelling and painof of 3-week the duration. left This started scrotum guided shortly after biopsy a of transrectal the ultrasound- Sulfamethoxazole/trimethoprim prostate was gland prescribed 1 month postoperatively as before prophylaxis. The our patient evaluation. hadlymphocytic a leukemia history on significant ibrutinib, forconcerns which chronic of was active infection. held The because prost adenocarcinoma of with a Gleason scorecompleted of 3 a + 3 two =sulfamethoxazole/trimethoprim, 6. 10-day The res course patient had ofThe antibiotics, prostatic specific levofloxacin, antibody and The was 6.31 white ng/mL blood before cell the count biopsy. was 12,000 cells/mm I

Downloaded from https://journals.lww.com/infectdis by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3YzRZ0r/T2srJHwqn6q/OQcNbjZdnss9zceunhKsPSxQ= on 07/29/2020 Downloaded from https://journals.lww.com/infectdis by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3YzRZ0r/T2srJHwqn6q/OQcNbjZdnss9zceunhKsPSxQ= on 07/29/2020 Letter to the Editor Infectious Diseases in Clinical Practice • Volume 00, Number 00, Month 2020

FIGURE 1. Ultrasound demonstrating acute epididymitis (asterisk).

FIGURE 2. A, Epididymis hematoxylin and eosin stain, magnification Â40. B, Hematoxylin and eosin stain, acute and chronic inflammation of the epididymis at Â200 magnification.