An unusual case of primary melioidotic prostatic disease: misdiagnosed as benign prostatic hyperplasia

Abstract Background: Melioidosis is a fatal infectious disease caused by Burkholderia pseudomallei . Its clinical manifestations are so varied that it has been called a great mimic. The primary melioidotic prostatic disease usually presents as an abscess of the prostate. This is the only documented case misdiagnosed as benign prostatic hyperplasia (BPH) because it does not present as a prostate abscess. Case presentation: A 66-year-old male with a history of hypertension and alcoholism, dysuria and fever lasting for three days. Laboratory tests of the patient showed a marked increase in inflammatory markers and a moderate decrease in platelets. CT showed prostatic hyperplasia with calcification. Thus, the preliminary diagnosis was BPH combined with urinary tract infection. Then, Multiple blood cultures were performed to isolate Burkholderia pseudomallei . The final diagnosis was primary melioidotic prostatic disease. The patient was treated with imipenem for two weeks and cured. Trimethoprim-sulfamethoxazole (TMP-SMX) was administered orally for twelve weeks after discharge. Conclusions： Melioidosis is mainly prevalent in tropical and subtropical climates between 20 ºN and 20 ºS, especially in Southeast Asia and northern Australia, with a high mortality rate. The primary melioidotic prostatic disease usually manifests as prostate abscess, so it is easy to be misdiagnosed as benign prostatic hyperplasia when the direct manifestation is dysuria. Burkholderia pseudomallei need to be repeatedly isolated from multiple samples to make a definitive diagnosis. After a definite diagnosis of melioidosis, adequate treatment with a course of sensitive antibiotics was given to cure it.