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Multidrug resistant epididymitis progressing to testicular infarct and orchiectomy.

Farber NJ, Slater RC, Maranchie JK - Case Rep Urol (2013)

Bottom Line: Ischemia occurs secondary to inflammation and edema of the spermatic cord with compression of arterial flow.This case highlights the fact that epididymitis does not always follow an indolent pathway to resolution.Progression of pain should prompt early imaging and intervention.

View Article: PubMed Central - PubMed

Affiliation: University of Pittsburgh, Graduate School of Medicine, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.

ABSTRACT
Global testicular infarction is a rare sequela of infectious epididymitis, with few reports in the urologic literature since the introduction of fluoroquinolones in the late 1980s. Ischemia occurs secondary to inflammation and edema of the spermatic cord with compression of arterial flow. We report a case of multidrug resistant epididymitis following prostate biopsy that progressed to global testicular infarction requiring orchiectomy. This case highlights the fact that epididymitis does not always follow an indolent pathway to resolution. Progression of pain should prompt early imaging and intervention. It further highlights the potential urologic consequences of the rising prevalence of multidrug resistant bowel flora in the United States, which will increasingly influence the management of presumed uncomplicated epididymitis, whether being primary or postprocedural.

No MeSH data available.


Related in: MedlinePlus

Right scrotal ultrasound with color Doppler interrogation at presentation to the ED showing A: right testis with preserved vascularity; B: right epididymis with enlargement and slightly increased vascularity.
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fig1: Right scrotal ultrasound with color Doppler interrogation at presentation to the ED showing A: right testis with preserved vascularity; B: right epididymis with enlargement and slightly increased vascularity.

Mentions: On presentation, he denied other associated symptoms, including fever, chills, nausea, vomiting, hematuria, difficulty voiding, dysuria, change in bowel function, or urethral drainage. Physical examination revealed focal tenderness in the right epididymis, without erythema or fluctuance. He was afebrile and his white blood count was 11.4. Urinalysis revealed 2+ leukocyte esterase, positive nitrites, with 53 white cells per high power field. Scrotal ultrasound confirmed enlargement of the right epididymis with increased vascularity suggestive of acute epididymitis (Figure 1). He was given a single intramuscular dose of ceftriaxone in the emergency room, started on oral doxycycline, and admitted for observation.


Multidrug resistant epididymitis progressing to testicular infarct and orchiectomy.

Farber NJ, Slater RC, Maranchie JK - Case Rep Urol (2013)

Right scrotal ultrasound with color Doppler interrogation at presentation to the ED showing A: right testis with preserved vascularity; B: right epididymis with enlargement and slightly increased vascularity.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860153&req=5

fig1: Right scrotal ultrasound with color Doppler interrogation at presentation to the ED showing A: right testis with preserved vascularity; B: right epididymis with enlargement and slightly increased vascularity.
Mentions: On presentation, he denied other associated symptoms, including fever, chills, nausea, vomiting, hematuria, difficulty voiding, dysuria, change in bowel function, or urethral drainage. Physical examination revealed focal tenderness in the right epididymis, without erythema or fluctuance. He was afebrile and his white blood count was 11.4. Urinalysis revealed 2+ leukocyte esterase, positive nitrites, with 53 white cells per high power field. Scrotal ultrasound confirmed enlargement of the right epididymis with increased vascularity suggestive of acute epididymitis (Figure 1). He was given a single intramuscular dose of ceftriaxone in the emergency room, started on oral doxycycline, and admitted for observation.

Bottom Line: Ischemia occurs secondary to inflammation and edema of the spermatic cord with compression of arterial flow.This case highlights the fact that epididymitis does not always follow an indolent pathway to resolution.Progression of pain should prompt early imaging and intervention.

View Article: PubMed Central - PubMed

Affiliation: University of Pittsburgh, Graduate School of Medicine, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.

ABSTRACT
Global testicular infarction is a rare sequela of infectious epididymitis, with few reports in the urologic literature since the introduction of fluoroquinolones in the late 1980s. Ischemia occurs secondary to inflammation and edema of the spermatic cord with compression of arterial flow. We report a case of multidrug resistant epididymitis following prostate biopsy that progressed to global testicular infarction requiring orchiectomy. This case highlights the fact that epididymitis does not always follow an indolent pathway to resolution. Progression of pain should prompt early imaging and intervention. It further highlights the potential urologic consequences of the rising prevalence of multidrug resistant bowel flora in the United States, which will increasingly influence the management of presumed uncomplicated epididymitis, whether being primary or postprocedural.

No MeSH data available.


Related in: MedlinePlus