Mullerian Duct Cyst Infection

A 48-year-old man presented with a 3-week history of fever and dysuria. No warmth or tenderness of the prostate was detected by digital rectal examination. Urinalysis revealed no hematuria or pyuria. Blood and urine cultures were sterile. A T2-weighted pelvic magnetic resonance imaging showed a teardrop-shaped midline cyst which extended above the prostate (Fig. 1A). Transurethral drainage of the cyst was performed, which drained greenish-yellow fluid (Fig. 1B). The fluid did not contain any sperm, and Escherichia coli grew from the fluid. The patient was diagnosed with a Mullerian duct cyst infection and was successfully treated with intravenous antibiotics.

Fig. 1.

A A T2-weighted image on the pelvic magnetic resonance imaging showing a teardrop-shaped midline cyst (arrow heads), extending above the prostate. B Drained greenish-yellow fluid from the cyst.

Mullerian ducts are paramesonephric ducts, which form fallopian tubes, uterus, and proximal vagina in women, while they usually regress in men.¹ Mullerian duct cyst results from failure of regression of the duct. It can be found in 1–5% of men, and the peak incidence is between aged 20 and 40.² Although Mullerian duct cyst is usually asymptomatic, urinary retention, urinary tract infection, ejaculatory impairment, and infection in the cyst can occur.^2,3 For Mullerian duct cyst infections, intravenous antibiotics with percutaneous aspiration, transurethral resection, or surgical excision are possible treatment options, depending on the cyst’s size and location and patient’s clinical condition.³