Question

Robert, an 81-year-old widower with early onset Alzheimer’s, was recently moved to a nursing home because he was having difficulty living on his own. Within a few weeks of his arrival, he developed a fever and began to experience pain associated with urination. He also began having episodes of confusion and delirium. The doctor assigned to examine Robert read his file and noticed that Robert was treated for prostatitis several years earlier. When he asked Robert how often he had been urinating, Robert explained that he had been trying not to drink too much so that he didn’t have to walk to the restroom. Please answer the following in detail: What would be your presumptive diagnosis for Robert and Why:

Answer 1

Based on the symptoms described, Robert’s presumptive diagnosis is prostatitis. Prostatitis is a disorder of the prostate gland that is usually associated with inflammation. It often causes painful or difficult urination, as well as pain in the groin, pelvic area, or genitals. Bacterial infections cause some but not all cases of prostatitis 1.

Robert’s history of prostatitis treatment several years earlier and his current symptoms of fever, pain associated with urination, and episodes of confusion and delirium suggest that he may have developed acute bacterial prostatitis. This type of prostatitis is a bacterial infection of the prostate gland that usually has sudden and severe symptoms 1.

Robert’s reluctance to drink too much water to avoid walking to the restroom may have contributed to his current condition. Dehydration can cause urine to become concentrated and irritate the bladder and urethra, leading to urinary tract infections (UTIs) 4. UTIs can also lead to prostatitis if left untreated 5.

It is important for Robert to receive prompt medical attention to prevent complications such as tubo-ovarian abscess (TOA), tubal factor infertility, ectopic pregnancy, chronic pelvic pain, and sepsis.