An Unusual Presentation of a Complicated Urinary Tract Infection With Features Concerning for Malignancy: A Diagnostic Challenge

Recurrent urinary tract infections (UTIs) in men are uncommon and frequently signal an underlying pathology. We present the case of a 73-year-old man who presented to the emergency department with a urinary burning sensation, foul-smelling urine, and fecal incontinence when straining to urinate. The patient had a history of recurrent UTIs, benign prostatic hyperplasia (BPH), and prior use of a chronic indwelling urinary catheter. Imaging revealed a 3.5 cm bladder stone, a markedly enlarged prostate with pelvic lymphadenopathy, lumbar vertebral fractures, and a rim-enhancing gluteal collection later confirmed as a hematoma. He improved with intravenous antibiotics and was discharged with plans to follow up as an outpatient for his prostate enlargement, vertebral fractures, and bladder stone management. This case illustrates therapeutic challenges in cases with multiple abnormal findings, as well as the risk of anchoring bias with overlapping clinical entities.