Xanthogranulomatous Prostatitis as a Differential Diagnosis in Lower Urinary Tract Symptoms: A Case Report

Authors

  • Augusto de Azevedo Barreto Hospital Universitário da Universidade Federal de Juiz de Fora. Núcleo Interno de Pesquisa em Urologia (NIPU), Juiz de Fora, Minas Gerais, Brasil. https://orcid.org/0000-0001-5721-7858
  • Filipi da Silva Kefler Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brasil. https://orcid.org/0009-0007-4781-852X
  • Abner Ramos de Castro Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brasil. https://orcid.org/0000-0001-5745-2671
  • Maria Clara Faria Lopes Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brasil. https://orcid.org/0009-0007-8692-6216
  • João Marçal Medeiros de Souza Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brasil.

Keywords:

Chronic Prostatitis, Granulomatous Prostatitis, Xanthogranulomatous Prostatitis, Chronic Pelvic Pain

Abstract

Introduction: Xanthogranulomatous Prostatitis (XP) is a rare inflammatory condition affecting men primarily in their sixth decade of life. It is characterized by lower urinary tract symptoms, elevated PSA, and digital rectal examination abnormalities that can mimic prostatic neoplasia. Definitive diagnosis is histopathological, evidenced by prostatic tissue infiltrated with foamy macrophages.

Case Report: An 81-year-old man with hypertension and dyslipidemia was referred to the Urology service due to elevated PSA (6.3 ng/dl). Initially asymptomatic with benign prostatic biopsy in 2015. In 2022, he developed severe lower urinary tract symptoms (IPSS>20), prostatic nodule on rectal examination, renal dysfunction (creatinine 2.3 ng/ml), and urinary retention (post-void residual of 545 ml). He underwent Endoscopic Prostate Resection, with histopathology confirming Xanthogranulomatous Prostatitis. He experienced significant improvement in symptoms and post-void residual (134 ml), while maintaining Doxazosin 2 mg/day.

Discussion: XP represents a diagnostic challenge due to its lack of specific clinical features, mimicking conditions such as prostatic neoplasia, conventional prostatitis, and benign prostatic hyperplasia. Laboratory and imaging tests are nonspecific, with diagnosis confirmed only by histopathological examination. The condition is likely underdiagnosed due to the low specificity of clinical findings.

Conclusion: Xanthogranulomatous Prostatitis is a rare condition that can simulate prostatic neoplasia. Its clinical management resembles that of other prostatitis types and benign prostatic hyperplasia. Surgical treatment, when indicated, is effective and provides a favorable prognosis.

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Published

2025-09-19

How to Cite

1.
de Azevedo Barreto A, da Silva Kefler F, Ramos de Castro A, Clara Faria Lopes M, Marçal Medeiros de Souza J. Xanthogranulomatous Prostatitis as a Differential Diagnosis in Lower Urinary Tract Symptoms: A Case Report. HU Rev [Internet]. 2025Sep.19 [cited 2025Dec.6];51. Available from: https://periodicos.ufjf.br/index.php/hurevista/article/view/48395

Issue

Vol. 51 (2025)

Section

Relato de Caso

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Copyright (c) 2025 Augusto de Azevedo Barreto, Filipi da Silva Kefler, Abner Ramos de Castro, Maria Clara Faria Lopes, João Marçal Medeiros de Souza

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