Brucella prostatitis presenting with prostatic abscess in a herdsman: a case report and literature review

Introduction: Brucellosis is a zoonotic infection caused by Brucella species, primarily transmitted through direct contact with infected animals or consumption of unpasteurized dairy products. Genitourinary involvement is uncommon, with prostatic infection being rare. We present a case of Brucella prostatitis with prostatic abscess in a herdsman, initially mimicking malignancy on imaging making it a challenging clinical entity. Case Presentation: We report a case of a 43-year-old male and highlighting the challenges in diagnosis and management of this uncommon manifestation of Brucellosis. He was a herder from an endemic area that presented with recurrent lower urinary tract symptoms over several visits. In his last visit he presented with a high-grade fever and dysuria. Although he initially denied risky exposures, he later admitted to consuming unpasteurized dairy products. Physical examination revealed a mildly tender prostate on digital rectal examination. Laboratory studies showed elevated inflammatory markers, and blood cultures grew Brucella melitensis. Transrectal ultrasound demonstrated a hypoechoic lesion consistent with a prostatic abscess. The patient was treated with doxycycline and rifampin for 8 weeks, resulting in full clinical recovery without relapse at follow-up. Discussion: Brucella prostatitis is rare, often misdiagnosed due to nonspecific symptoms and radiologic overlap with prostate cancer. Few cases are reported in the literature, most in occupationally exposed individuals. Our case emphasizes the need to consider Brucella in endemic areas, particularly in patients with unexplained prostatic abscess. Conclusion: The case report underscores the importance of considering brucellosis as a differential diagnosis, particularly in patients with occupations that have close encounters with animals. Early recognition of Brucella prostatitis allows prompt initiation of targeted antibiotic therapy, preventing complications and unnecessary surgical intervention.