Introduction
This case presents a 42-year-old man who presents to the emergency department (ED) with a constellation of symptoms including dysuria, low back pain, inability to fully empty his bladder, severe perineal pain, along with fevers and chills. On examination, his vital signs are notable for a high temperature of 104.0 F, tachycardia with a pulse of 138, and increased respiratory rate. Additionally, a digital rectal examination (DRE) reveals an enlarged, extremely tender, swollen, and warm prostate. These findings raise suspicion for a potentially serious condition, and further evaluation and management are required.
Discussion
The presenting symptoms and examination findings in this case are consistent with acute bacterial prostatitis (ABP). ABP is an infection of the prostate gland, typically caused by ascending urinary tract pathogens. The condition is more commonly observed in younger men and is associated with significant morbidity if not promptly recognized and treated.
Dysuria, or painful urination, is a common symptom of ABP and is attributed to the inflammation and irritation of the prostatic urethra caused by the infection. The prostatic urethra runs through the prostate gland, making it susceptible to infection and resulting in symptoms of dysuria. The patient’s report of low back pain may also be related to the infection, as the prostate shares anatomical proximity to the sacrum and can refer pain to the lower back region.
The patient’s complaint of an inability to fully empty his bladder points to obstructive symptoms, which can occur with prostatic inflammation and swelling. Inflammation of the prostate can compress the prostatic urethra and impair the flow of urine, leading to incomplete emptying of the bladder. This may further contribute to dysuria and can result in urinary retention.
The severe perineal pain reported by the patient is a characteristic symptom of ABP and is often described as a deep, aching pain in the perineum. The perineum is the region between the scrotum and the anus, and the infection and inflammation of the prostate can cause this pain to radiate to the surrounding tissues. The pain is reported to worsen with standing and is somewhat relieved with lying down, which may be explained by changes in blood flow and pressure on the prostate in different positions.
The presence of fevers and chills suggests systemic involvement and is indicative of an infectious process. In ABP, the infection can spread from the prostate into the bloodstream, leading to bacteremia and subsequent systemic symptoms such as fever and chills. These systemic symptoms require urgent evaluation and treatment, as untreated ABP can lead to complications, including sepsis.
The findings on the DRE support the diagnosis of ABP. The DRE reveals an enlarged prostate that is extremely tender, swollen, and warm to touch. These findings are consistent with acute inflammation and infection of the prostate. The prostate gland is normally not palpable on DRE, but in cases of inflammation or infection, it may become enlarged and tender. The warmth observed on palpation is a result of increased blood flow and inflammation in the affected area.
Conclusion
In this case, the patient’s presenting symptoms and examination findings are consistent with acute bacterial prostatitis. The patient’s dysuria, low back pain, obstructive symptoms, severe perineal pain, and systemic symptoms (fevers and chills) are characteristic of ABP. The DRE findings of an enlarged, extremely tender, swollen, and warm prostate support the diagnosis of ABP. Prompt evaluation and initiation of appropriate antimicrobial therapy are essential to prevent complications and promote resolution of symptoms.
