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A 65-year-old male patient presented with complaints of swelling and pain over the right inguinoscrotal region for the past two weeks. The patient had no significant previous medical history and no past surgical history. There was no history of vomiting or diarrhea. Local examination revealed a warm, tender swelling in the right inguinoscrotal region. Blood investigations showed neutrophilic leukocytosis with normal liver and renal function tests. An abdominal and scrotal ultrasound (USG) was performed, which revealed right epididymoorchitis with a multiloculated septated collection within the scrotal sac suggestive of pyocele. The spermatic cord structures were thickened, indicating funiculitis [Table/Fig-1]. The patient underwent a right high orchidectomy, and the postoperative period was uneventful. Histopathology of the specimen showed features of acute inflammation. Seven months following the surgery, he noticed a serous discharge from the right inguinal region with mild swelling and pain at the postoperative site. No definite spermatozoa were identified in the discharge. He was referred for a plain Computerised Tomography (CT) abdomen to the radiology department. Since there was a small opening in the right inguinal region from which discharge was seen, non-ionic water-soluble iodinated contrast was injected through the opening, and a CT fistulogram was performed. The CT fistulogram demonstrated contrast opacification of a tubular structure reaching up to the right seminal vesicle, suggestive of the vas deferens. Hence, a diagnosis of vasocutaneous fistula was made [Table/Fig-2]. Magnetic Resonance Imaging (MRI) screening was also performed, confirming the CT findings [Table/Fig-3]. The prostate and the rest of the abdominal organs were normal. The patient was advised to undergo surgery, and sinus tract excision was performed. The patient is doing well with no evidence of discharge at the postoperative site.

A 28-year-old male patient presented with right-sided scrotal swelling and pain for the past two months. He had a history of loss of appetite and weight, as well as fever for the past ten days. He had no comorbidities. Complete blood count and blood chemistry, including fasting blood glucose, renal, and liver function tests, were normal. Scrotal ultrasound revealed an enlarged right testis and epididymis with heterogeneous echotexture in the right testis and multiple small hypoechoic lesions within it. There was also a focal fluid collection with septations in the right scrotal sac, adjacent to the epididymis [Table/Fig-1]. Increased vascularity in the testis and epididymis indicated inflammation. These ultrasound findings suggested right epididymo-orchitis with an abscess in the extra testicular space of the right scrotal sac, near the epididymis. Abdominal ultrasound was normal. Chest X-ray revealed multiple miliary nodules in both lung fields and a small left-sided pleural effusion, which was confirmed on chest CT [Table/Fig-2a,b]. Contrast-enhanced magnetic resonance imaging of the brain showed multiple small enhancing lesions in the bilateral cerebral and cerebellar hemispheres, as well as the brainstem, with smooth leptomeningeal enhancement. These findings were suggestive of multiple tuberculomas with meningitis [Table/Fig-2c,d]. The patient later underwent drainage of right scrotal abscess and right epididymo-orchidectomy, as the epididymis had sloughed off due to infection [Table/Fig-3]. Mycobacterium tuberculosis was detected in the pus sample using the Mycobacterium tuberculosis DNA test, with no resistance to rifampicin. The patient responded well to antitubercular therapy and is currently being followed up.

An acute scrotum is a common clinical scenario prompting urologic involvement. Scrotal ultrasonography with Doppler is the main imaging modality utilized for the evaluation of an acute scrotum and can help distinguish testicular torsion from epididymoorchitis, two common causes of testicular pain. Testicular infarction is a rare but potential complication of epididymoorchitis. We report a case of epididymoorchitis presenting with reversal of testicular diastolic flow concerning for impending testicular infarction but with a non-ischemic testis on scrotal exploration and repeat scrotal ultrasonography post-operatively.

The article presents a case study of a disseminated tuberculosis presenting as scrotal swelling in a 28-year-old male patient. Topics discussed include the unusual presentation of tuberculosis as scrotal swelling, the diagnostic findings of scrotal ultrasound and MRI, and the successful management with antitubercular therapy and surgical intervention.

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area ( n = 327, 83.8%), as epididymo-orchitis ( n = 204, 58%), orchitis ( n = 112, 31.8%) and epididymitis ( n = 11, 3.1%). In female patients, pyelonephritis ( n = 33/38, 86.8%) was significantly higher than in male patients ( n = 11/352, 3.1%; p< 0.0001). The mean blood leukocyte count was 7530 ± 3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate ( ESR) and C-reactive protein ( CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p< 0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease. [ABSTRACT FROM AUTHOR]

We report a case of isolated tuberculous epididymoorchitis developing in a patient after haematopoietic stem cell transplantation (HSCT). Forty-four-year-old male was admitted to the hospital with scrotal pain and swelling 6 months after an allogeneic HSCT using a fully-matched sibling donor because of his acute myeloid leukemia. There were scrotal tenderness, thickening and erythema on the right side. Brucella standard tube agglutination test was negative. Increased scrotal skin thickening, edema in the right epididymis and increased testicular vascularization were detected on ultrasonography. He was readmitted to our hospital with recurrent scrotal pain after 3 months of partial improvement with oral ciprofloxacin administered for a diagnosis of right epididymoorchitis. Pelvic magnetic resonance imaging revealed bilateral epididymoorchitis and scrotal abscess. Acid fast bacilli were detected on Ehrlich-Ziehl-Neelsen staining of the content of abscesses drained under local anesthesia. Mycobacterium tuberculosis complex was isolated on the 24th day of quadruple antituberculosis therapy. Scrotal fistula developed on the first month of therapy which healed spontaneously after discontinuation of immunosuppressive agents. Full recovery was achieved after six months of antituberculosis therapy. As a result, tuberculous epididymoorchitis should be kept in mind in the presence of chronic epididymoorchitis developing in patients receiving immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

Epididymoorchitis caused by Brucella species is a rare infection. In this report fi ve cases of epididymoorchitis due to brucellosis are presented with their laboratory and clinical fi ndings. All patients complained of fever, swollen and painful testicles. The duration of their complaints varied between 10 and 21 days. All of these patients had unilateral epididymoorchitis. Brucellosis was diagnosed serologically in all patients. Brucella melitensis was isolated from the blood culture of one patient. Four patients were treated with rifampicin and doxycycline and one patient was treated with streptomycin and doxycycline. In all cases, complete resolution was achieved with medical treatment and relapse did not occur. Brucellosis should be considered in the differential diagnosis of patients presenting with epididymoorchitis in endemic areas. [ABSTRACT FROM AUTHOR]

Summary: Background: Epididymoorchitis is the most frequent genitourinary complication of brucellosis. Methods: This prospective study was conducted between February 2001 and January 2004, prospectively. Male patients diagnosed with brucellosis were included in this study and evaluated for testicular involvement. Results: Epididymoorchitis was detected in 17 out of 134 (12.7%) male patients with brucellosis. Mean age of the patients was 36.9±7.1 years. Twelve patients (70.6%) had acute, four patients (23.5%) had subacute, and one patient (5.9%) had chronic brucellosis. The most common symptoms were scrotal pain (94%) and swelling (82%). Eleven patients had unilateral epididymoorchitis, four had unilateral orchitis and two had unilateral epididymitis. A testicular abscess was detected in one patient. Sperm analysis was performed on 14 patients. Five patients had aspermia and eight had oligospermia. Combined antibiotic therapy was started and continued for 6–8 weeks. Orchiectomy was required for two patients and granulomatous orchitis was detected in the resected specimens. Relapse occurred in only one patient. Three patients had permanent oligospermia and one patient had permanent aspermia after the antibiotic therapy. Younger age, high C-reactive protein level and blood culture positivity were statistically significant differences between the patients with and without epididymoorchitis. Conclusions: Brucellosis should be considered in the diagnosis of scrotal diseases in endemic areas. A conservative approach is usually adequate for managing brucellar epididymoorchitis. However, infertility problems may develop in these patients. Well-designed further investigations are needed to explain the relationship between brucellar epididymoorchitis and infertility in man. [Copyright &y& Elsevier]

Brucellosis is a common zoonotic infection worldwide caused by Brucella species. Central nervous system involvement is a serious complication of brucellosis, and the clinical presentation is quite heterogeneous. The genitourinary system may be affected. Epididymoorchitis is the most common type of urinary tract involvement, which can cause serious complications. Herein, we present a case of brucellosis in a child with a rare combination of epididymo-orchitis and neurobrucellosis not encountered previously in the literature. [ABSTRACT FROM AUTHOR]

Abstract Background Brucella epididymoorchitis(BEO) is a focal complication of human brucellosis and has been reported in 2-20% of patients with brucellosis. Brucellosis is an endemic disease in Iran. The incidence of the disease in this country is 34 per 100 000 per year. Methods In a retrospective study, we identified 30 cases of Brucella epididymoorchitis in two teaching hospitals in the north of Iran during 1997-2009. Findings Epididymoorchitis occurred in 11.1% of male patients with brucellosis. The average age was 25.5 ± 12.43 years. Pain and scrotal swelling (100%) and fever (96.7%) were the most common symptoms. Different treatment regimens were administered including doxycycline plus rifampin (60%), doxycycline plus rifampin plus aminoglycoside for the first two weeks (36.6%) and doxycycline plus cotrimoxazole(3.4%). Ten percent of the patients did not respond to antibiotic therapy and required surgical drainage or orchiectomy. Conclusions In brucellosis endemic areas, clinicians who encounter patients with epididymoorchitis should consider the likelihood of brucellosis. A careful history and physical examination and an immediate laboratory evaluation help to make a correct diagnosis. Generally, classical therapy of brucellosis is adequate for the treatment of epididymoorchitis.

Brucellosis is a systemic infection in which any organ or system of the body can be involved. The most common osteoarticular involvements are sacroiliitis, spondylitis and peripheral arthritis. However, bursitis is a rarely observed osteoarticular manifestation of brucellosis. In this article, a case of brucellosis with spondylodiscitis, bursitis and epididymo-orchitis is presented. [ABSTRACT FROM AUTHOR]

Behçet's disease is a systemic vasculitis affecting arterioles and venules and is characterized by recurrent oral ulcers, genital ulcers and ocular inflammation. It can involve any organ but joints, skin, central nervous system and gastrointestinal tract are the most common sites. Here we report an 11-year-old Behçet's disease patient presenting with attacks of myositis accompanied by epididymoorchiis and periodic fever attacks as well as a separate attack of thrombophlebitis. [ABSTRACT FROM AUTHOR]

We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products) and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucelosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.

Introduction: To assess the clinical presentation of patients who underwent surgical exploration for acute scrotum and to investigate the potentially related factors for differential dignosis., Material and Methods: We retrospectively analyzed the medical records of 97 patients who underwent surgical exploration for acute scrotum between May 2007 and July 2013. The patients were divided into two groups as follows: Group1 included patients with testicular torsion (TT) and Group 2 contained patients with acute scrotal pathologies other than TT, including torsion of the testicular appendage, epididymo-orchitis, trauma and Henoch-Schönlein purpura. The physical examination findings, colour Doppler ultrasound (CDUS) and laboratory findings for the groups were compared., Results: In total, 97 scrotal explorations were carried out for acute scrotum. Group 1 included 72 patients (74.2%) and Group 2 included 25 patients (25.8%). Group 2 was comprised of patients with torsion of the testicular appendage (n = 13), epididymo-orchitis (n = 8), testicular trauma (n = 2) and Henoch-Schönlein purpura (n = 2). In Group 1, 32 cases (44.4%) presented to a hospital less than 6 hours after onset of pain. More than half (64%) of Group 2's cases presented more than 24 hours after pain onset. Fever and pyuria appeared more frequently in Group 2 than in Group 1 and the results reached statistical significance (p = 0.001 and p = 0.044, respectively). Group 1 had more testicular tenderness than Group 2 (p <0.001). Our testicular salvage rate was 59.7%, and 40.3% of patients underwent orchiectomy., Conclusions: CDUS predicted the diagnosis of TT (sensitivity 98.6%). Furthermore, clinical findings may also play a substantial role in the differential diagnosis of acute scrotum.