Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6009
Peer-review started: February 3, 2021
First decision: April 25, 2021
Revised: May 6, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: July 26, 2021
Prostatitis caused by Brucella infection is rare and usually lacks typical lower urinary tract symptoms. However, Brucella infection can cause serum prostate-specific antigen levels to become abnormally elevated. When concurrent with lumbar vertebra infection and erosion, brucellosis can easily be misdiagnosed as prostate cancer with bone metastasis.
A 45-year-old man complained of recurrent low back pain and fever for 2 wk. Magnetic resonance imaging of the lumbar vertebrae showed abnormal signs at the rear of the L4–5 vertebral body. Serum prostate-specific antigen level was 17.64 ng/mL, and positron emission tomography/computed tomography suggested the possibility of prostate cancer with liver and lumbar metastases. The patient was transferred to our department for further treatment. He experienced repeated bouts of fever and low back pain during hospitalization. Biopsy results indicated prostatitis. There was no significant increase in white blood cell count or procalcitonin levels. The Mycobacterium tuberculosis smear and antibody detection results were negative. Cefoperazone sulbactam was not effective. Blood culture test results were positive for brucellosis, confirming the diagnosis of brucellosis. After oral anti-infection treatment with doxycycline and rifampicin, the body temperature gradually returned to normal, and lumbago improved. After continuous treatment for 6 mo, the patient recovered.
In patients with low back pain and fever accompanied by elevated prostate-specific antigen levels and lesions of the prostate and lumbar spine, a detailed medical history and blood and urine cultures should be obtained, and attention should be given to the local epidemic infectious disease situation.
Core Tip: Brucella infection of both the prostate and lumbar spine is rare. We present a case of such an atypical presentation accompanied by fever and low back pain. Abnormally elevated serum prostate-specific antigen levels and abnormally high metabolic signals in the prostate and lumbar spine were indicated on positron emission tomography/computed tomography scans, which were suggestive of a diagnosis of prostate cancer with lumbar metastases, except for the unexplained periodic fever. Blood culture and agglutination tests were used to confirm brucellosis. This case highlights the need to pay more attention to and identify the atypical symptoms caused by Brucella infection.