Klebsiella pneumoniae Prostatic Abscess Complicated by Septic Pulmonary Emboli in a Patient With Uncontrolled Diabetes Mellitus

Prostatic abscess is an uncommon complication of bacterial infection that may be associated with bacteremia and metastatic infection, particularly in patients with diabetes mellitus.A 47-year-old man with poorly controlled diabetes presented with fever and systemic illness.His white blood cell count was 26 × 109/L, and C-reactive protein (CRP) concentration was 348 mg/L; blood cultures grew Klebsiella pneumoniae.Persistent illness after five days of intravenous antimicrobial therapy prompted abdominal and pelvic imaging.The CT suggested a prostatic abscess, and a pelvic MRI demonstrated extensive intraprostatic collections with near-complete replacement of the normal prostatic architecture.Right-sided pyelonephritis and a small right perirenal collection were also identified.Subsequent dyspnea and a new oxygen requirement prompted thoracic imaging, which demonstrated multiple bilateral pulmonary nodules, including cavitating lesions.These findings were considered consistent with probable septic pulmonary emboli in the setting of a deep genitourinary infection.Echocardiography was not completed before transfer, limiting exclusion of an endocardial source.Following prostatic drainage, intravenous antibiotic therapy, and management of hyperglycemia, the patient improved clinically.Follow-up pelvic MRI demonstrated resolution of the prostatic abscess.This case highlights the importance of investigating an occult abscess when systemic infection persists despite antimicrobial therapy and considering septic pulmonary embolism when new cavitating pulmonary nodules accompany bacteremia.