Dual Urinary Tract Pathology in a Frail Elderly Man

A prostatic abscess is a rare but critical complication of urinary tract infections that may coexist with upper urinary tract involvement, such as pyelonephritis. This case report describes an 84-year-old frail gentleman with dementia who was admitted with a fall into the Accident and Emergency Unit. He was noted to be febrile, with suprapubic tenderness and raised infection markers. He underwent a CT trauma series, which revealed right kidney pyelonephritis with a prostatic abscess. A broad-spectrum intravenous antibiotic was started with no improvement, and the patient was not suitable for surgical drainage. He received multiple courses of long-term antibiotics, and his condition improved with the resolution of the abscess. Early imaging is generally indicated for patients with atypical presentations, poor response to therapy, or underlying immunocompromised status. In this case, it helped to confirm acute pyelonephritis and identify complications, including abscess formation.