A CURIOUS CASE OF URINARY RETENTION

A 45 year-old male presented with acute onset urinary retention. 1.8L of urine was catheterised in A&E and he was found to have low grade fever. He was started on ciprofloxacin and an alpha-blocker under the presumptive diagnosis of prostatitis but failed to void after 2 weeks and began reporting sweats and lower back pain. He was diagnosed with Human Immunodeficiency Virus (HIV) infection in the past but was not antiretrovirals; CD4 count was 350 cells/mm3 and viral load 22,000 copies/mL.Without a urological cause being established, a neurological review was requested and examination suggested absent third and fourth sacral dermatomal sensations and anal reflex. MRI revealed suspicious enhancement over the lower thoracic cord. CSF protein was 1.44 g/L, glucose 2.3 mmol/l, 62 leukocytes (60% mononuclear), negative acid-fast bacilli, TB PCR and culture, cryptococcal antigen, and viral PCR. CSF HIV viral load was 140,000 copies/mL.He was started empirically on four-drug anti-tuberculosis regimen and prednisolone. After 6 weeks he began to urinate and discharged without catheter. At 2 months, he reported no voiding difficulties.Urinary retention may occasionally be the only apparent manifestation of an underlying neurological condition. Our patient was found to have chronic meningitis and symptoms improved with treatment.