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Introduction: Transrectal ultrasound guided biopsy prostate biopsy has its infective complications especially in immunocompromised patients; portal vein thrombosis is a severe form of its complications. Case Report: A 66-year-old male, with background of myeloproliferative disorder (JAK2 positive). Underwent TRUS biopsy, later developed intra-abdominal sepsis with portal vein thrombosis and splenic collection. Multi-disciplinary team approach agreed on conservative management with intravenous antibiotics and full anti-coagulation and ultrasound guided aspiration of the splenic collection. Patient had full investigations including Computed Tomography scans at presentation, an ultrasound-guided aspiration of spleen and full septic and viral study. Patient had full recovery with spleen salvage. Follow up ultrasound study revealed partial recanalization of the portal vein. From the urology perspective, prostate biopsy histology showed microacinar adenocarcinoma and patient enlisted on active surveillance programme. In addition, Hydroxycarbamide recommended by hematologist for the essential thrombocytosis management.We discuss our case as a rare complication of TRUS prostate biopsy, precipitated with background of Janus Kinase 2 positive myeloproliferative disorder. Strategies to minimize the risk of sepsis after prostate biopsy include targeted prophylaxis with a prior rectal swab and transperineal biopsy route. We discuss also the immunocompromised and thrombogenicity state of our case with the challenges in the management choice between conservative management and splenectomy with its complications. Conclusion: The immune compromised patients requiring evaluation with a prostate biopsy, would benefit from a transperineal rather than transrectal prostate biopsy. Furthermore, an individual antibiotic prophylaxis strategy should be discussed with a microbiologist. |
