Isolated Prostatic Tuberculosis Coexisting with Benign Prostatic Hyperplasia: A Case Report.

Abstract

Background: Prostatic tuberculosis is a rare manifestation of genitourinary tuberculosis and an uncommon form of extrapulmonary tuberculosis. Because its clinical presentation is often nonspecific and closely resembles benign prostatic hyperplasia (BPH), chronic prostatitis, or prostate carcinoma, the diagnosis is frequently delayed and often established only after histopathological examination of prostatic tissue. Reporting such cases is important to increase clinical awareness and facilitate timely diagnosis, particularly in tuberculosis-endemic regions.

Case presentation: A 70-year-old man presented with a one-month history of lower urinary tract symptoms complicated by recurrent urinary retention requiring repeated urethral catheterization. His prostate-specific antigen level was 5.5 ng/mL, and ultrasonography demonstrated a 59-gr enlarged prostate, consistent with benign prostatic hyperplasia. He subsequently underwent transurethral resection of the prostate. Histopathological evaluation revealed caseating granulomatous inflammation strongly suggestive of prostatic tuberculosis coexisting with benign prostatic hyperplasia, in the absence of primary microbiological or molecular confirmation, with no evidence of malignancy. Anti-tuberculosis treatment was commenced, and the patient showed significant clinical improvement during follow-up.

Conclusion: Prostatic tuberculosis remains a diagnostic challenge, as it can silently coexist with benign prostatic hyperplasia in endemic regions; this case highlights the value of routine histopathological examination of resected tissue for uncovering unsuspected disease and ensuring prompt anti-tuberculous therapy.