Chronic Granulomatous Prostatitis

Overview

Chronic granulomatous disease (CGD) is an immunodefiency disease, that is, a disorder in which the immune system does not function properly. It affects the white blood cells of the innate immune system, the branch of the immune system that responds in a nonspecific way to invading microorganisms. There are many forms of this CGD, all caused by various genetic mutations. The immunodeficiency leads to infections and inflammation in various parts of the body. When CGD causes chronic inflammation of the prostate, it is called chronic granulomatous prostatitis.

Cause

Chronic granulomatous disease results from one of at least 410 identified mutations in the genes that code for an enzyme called phagocyte NADPH oxidase. In normal individuals, this enzyme allows a certain type of white blood cell, the phagocyte, to produce toxic free radicals for use in killing bacteria, fungi, and other infectious organisms. Phagocytes normally work by engulfing or “eating” these organisms (“phagocyte” literally means “eating cell”), then killing the organism with free radicals. Without the free radicals produced by the enzyme, phagocytes tend to surround invading organisms, forming little clumps or nodules called granulomas (or granulomata). The presence of numerous granulomas gives CGD its name.

Chronic Granulomatous Prostatitis

The prostate is one of the organs that may be affected by CGD. Chronic granulomatous prostatitis is a disease characterized by recurrent granuloma-type inflammation in the prostate. The symptoms can resemble those of carcinoma, but a biopsy will show a different pathology. The granulomas may be nonspecific clumps of phagocytes, or they may consist of phagocytes that have developed a spindle (elongated) shape. The granulomas may also be associated with infections, with signs such as dead tissue, pus, fungal cells, and high concentrations of neutrophils (a type of white blood cell associated with infectious organisms).

Treatment

CGD is treated with various measures aimed at making up for the deficiencies of the innate immune system. Long-term treatments include the following antibiotic therapy (to help stave off bacteria) and interferon, a substance that helps activate the immune system. Severe acute infections may be treated by transfusions of healthy white blood cells from blood donors. Because the white blood cells involved in CGD are part of the innate immune system, which is not specific, these cells work just as well in the recipient’s body as in the donor’s body. Bone marrow transplants may be considered because marrow from healthy donors contains blood stem cells that produce normal white blood cells.

References

• “Chronic Granulomatous Disease.” Merck Manual of Diagnosis and Therapy.
• Paul G. Heyworth et al. “Chronic granulomatous disease.” Current Opinion in Immunology October 2003; 15(5):578-584.
• Michael W. Stanley et al. “Granulomatous prostatitis: A spectrum including nonspecific, infectious, and spindle cell lesions.” Diagnostic Cytopathology 2006; 7(5):508-512.