Thursday, December 8, 2011

Odd Set of Risk Factors

A 30 year old man comes in with fevers, chills, malaise, and myalgias. He has no significant past medical or surgical history. He takes no medications. He has no allergies. On review of systems, he notes dysuria, perineal pain, and cloudy urine. He also has urinary dribbling and hesitation. He initially thought this was a urinary tract infection and took a 2 week course of amoxicillin-clavulanate (Augmentin) but his symptoms persisted. He is an avid bike rider and has been training for 8-hours a day. He is not currently sexually active. He denies smoking, but drinks a beer occasionally and smokes marijuana occasionally.

If a biopsy were taken, the image above might be found.

Challenge: If this is more than a UTI, what is it?

Image shown under Creative Commons Attribution Share-Alike License.

1 comment:

Craig Chen said...

Odd Set of Risk Factors

The risk factors of trauma, dehydration, and sexual abstinence in addition to failure of antibiotic treatment for UTI suggest acute bacterial prostatitis. Eradication of the organism often takes 4-6 weeks of treatment with TMP-SMZ or a fluoroquinolone as first-line therapy. The image shows neutrophil infiltration into the prostate.

Sources: UpToDate; Wikipedia.