Filarial Epididymitis: A Diagnostic Challenge in Pediatric Acute Scrotum

Abstract

Genital lymphatic filariasis (LF) is a condition that can present both acutely and chronically, complicating its diagnosis due to nonspecific symptoms. This case report describes an 11-year-old boy who presented with symptoms of acute scrotum. Initial Doppler ultrasound suggested acute epididymo-orchitis; however, despite conservative management, the symptoms persisted, prompting surgical exploration. The surgery revealed an edematous epididymis with a cystic lesion, leading to a diagnosis of filarial epididymitis. This case highlights the diagnostic challenges associated with genital filariasis and underscores the importance of considering it in the differential diagnosis of scrotal swelling, especially in endemic regions. Surgical intervention not only confirms the diagnosis but also alleviates symptoms and helps prevent future complications such as infertility.

Keywords: acute scrotum; filarial epididymitis; filariasis; paediatric surgery; public health.

Figure 1. USG of the left scrotum (at the time of admission) showing features of epididymo-orchitis – increased vascularity and secondary hydrocele

Figure 2. USG of the left scrotum showing a hypoechoic mass in the left epididymal head

Figure 3. Surgical exploration of the left scrotum showing filarial cystic lesion with the epididymis

Figure 4. Microscopic slide showing seminiferous tubules and cross-section of the filarial worms (40x magnification)

Figure 5. Microscopic slides showing the cross-section of the filarial worm with thick walls (400x magnification)