Testicular loss following bacterial epididymo-orchitis: Case report and literature review

Abstract

Epididymo-orchitis rarely leads to abscess formation and global testicular infarction/loss, particularly in the setting of appropriate antibiotic therapy. The imaging modality used when monitoring for testicular ischemia is ultrasonography. However, as described in the literature, testicular pathology may not be evident on routine imaging. We describe two cases of recurrent bacterial epididymo-orchitis, complicated by testicular abscess resulting in testicular infarction. This rare, nevertheless significant, complication occurred in both patients despite receiving appropriate extended antibiotic therapy. Both cases demonstrate the limitations of ultrasonography alone, suggesting that a high level of clinical suspicion must be maintained when ultrasound evaluation proves to be inconsistent with the clinical presentation. These cases demonstrate the importance of monitoring for warning signs of ischemia, as early recognition may lead to reperfusion interventions and ultimately testicular salvage.

Fig. 1.

Histopathological findings of epididymoorchitis in Case 1: Infarcted seminiferous tubules associated with an acute inflammatory infiltrate; hematoxylin and eosin ×200.

Fig. 2.

Histopathological findings of epididymoorchitis in Case 2: Infarcted seminiferous tubules associated with an acute inflammatory infiltrate, hematoxylin and eosin ×20.