PMC8577437_01
(A) Computed tomography showing a left inguinal hernia (red arrowhead), foreign body (white arrow) in the urethra, and irregular low-density area (yellow arrow), indicating an abscess in the penile corpus cavernosum. (B) The foreign body was removed and identified as a pearl with a thread.
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Computed tomography (CT) revealed a foreign body in the urethra, presenting bilateral hydronephrosis and an irregular low-density area with inflammation, which was consistent with an abscess in the corpus cavernosum (Fig. 1A). The foreign body, identified as a pearl with thread (Fig. 1B), was manually removed and a catheter was placed in the bladder to relieve urinary retention.
(A) Gram staining (magnification: x1000) revealed gram-positive rods (yellow arrow). (B) The colonies were circular, flat, and pinhead, with a zone of alpha-hemolysis. (C) Susceptibility testing of the isolates from blood culture with the E-test revealed minimum inhibitory concentrations for penicillin and ampicillin of 0.047 and 0.094 microg/mL, respectively.
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The aerobic and anaerobic blood cultures showed presence of gram-positive rods after 1-day incubation (Fig. 2A). The isolates grew as circular, flat, and pinhead colonies, with an alpha-hemolytic zone on 5% sheep blood agar after additional 2 days of incubation under 5% CO2 at 37  C (Fig. 2B). The E-test showed penicillin and ampicillin to have minimum inhibitory concentrations of 0.047 and 0.094 microg/mL, respectively, indicative of susceptibility according to the Clinical and Laboratory Standards Institute criteria (Fig. 2C).
Incision of the right corpus cavernosum contributed to drainage of a large amount of pus.
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Furthermore, incisional drainage of the right corpus cavernosum was performed on day 9 (Fig. 3).
Clinical course of the patient. The patient did not improve despite the removal of the foreign body and the indwelling of the catheter. Appropriate microbiological examinations of blood cultures revealed the causative agent to be L. paragasseri. Enhanced CT imaging on day 8 revealed progression toward multilocular abscesses in the corpus cavernosum (yellow arrows). Incisional drainage of the right corpus cavernosum was performed on day 9. Pus culture also revealed L. paragasseri in the same way. Intravenous ampicillin/sulbactam was administered according to the susceptibility testing. Thereafter, ampicillin/sulbactam was changed to oral amoxicillin/clavulanate on day 40 confirming reduced abscess size by CT imaging on day 39. Consequently, oral amoxicillin/clavulanate was discontinued, confirming the disappearance of the abscess without recurrence and sequelae.
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CT findings, and amoxicillin/clavulanate was discontinued. Consequently, the patient remained disease-free without recurrence or sequelae during a 2-year follow-up period (Fig. 4).