PROSTATIC AND INTESTINAL TUBERCULOSIS IN THE ELDERLY

INTRODUCTION

Prostatic tuberculosis (TB) is very rare and is mainly found in immunocompromised patients. Its
symptoms are nonspecific. The simultaneous presentation of intestinal and prostatic foci is an
extraordinary finding in the literature.

CLINICAL CASE

A 66-year-old male presents for preoperative evaluation of an inguinal hernia. He reports a weight
loss of approximately 10 kg over 2 years. HIV Elisa test: negative. Digital rectal examination reveals
an enlarged prostate with increased consistency and a palpable nodule in the left lobe. Total PSA:
62.54 mg/ml, Free PSA: 3.66 mg/ml, PSA L/T ratio: 0.05. Biopsy reports Granulomatous Prostatitis.
Urine and sputum acid-fast bacilli (AFB) smear: negative. Review of the biopsy and Ziehl-Neelsen
staining reveals positive caseating epithelioid granulomas. The patient experiences acute
abdomen. CT scan shows nodular images in both apices, thickening of the small intestine with
predominant involvement of the terminal ileum, and fat alteration at the mesenteric border.
Intraoperative examination confirms perforation of a lesion in the terminal ileum. Biopsy reports
active tuberculoid granuloma. The patient received chemotherapy treatment with complete
recovery.

DISCUSSION

Prostatic TB is an incidental finding post transurethral resection of the prostate or biopsy for
suspected prostate cancer. It is challenging to identify Mycobacterium in prostatic tissue. The
presence of epithelioid granulomas, Langhans-type giant cells, and caseous necrosis justifies
chemotherapy treatment.

CONCLUSION

Prostatic TB is an extremely rare disease with nonspecific and difficult-to-diagnose symptoms. New
tests with greater diagnostic accuracy for extrapulmonary TB are being implemented.
Antituberculous chemotherapy is mandatory. Lifelong follow-up is recommended due to the high
relapse rate.