Case report of bilateral testicular infarction due to severe bilateral epididymo-orchitis: A catastrophic complication causing castration

Highlights • A rare case of bilateral epididymo-orchitis complicated with bilateral testicular infarction. • Presentation was fever with persistent, unresolved pain and scrotal swelling. • Antibiotic therapy failed to halt disease progression of bilateral testicular ischemia. • Bilateral orchidectomy performed as both testes were not viable, resulting in castration and lifelong testosterone replacement.
Introduction Testicular infarction as a result of severe epididymo-orchitis is an uncommon urological emergency, with only a handful of reported cases in literature. We report an even rarer case of bilateral epididymo-orchitis complicated with testicular infarction, resulting in bilateral orchidectomy. Presentation of case 49 year old gentleman presented with fever, persistent, unresolving pain and scrotal swelling of two weeks duration. Despite close clinical monitoring, timely ultrasounds of the testis and antibiotics there was an inexorable progression to bilateral testicular ischemia. Discussion This is only the second reported case of this nature in published literature. Epididymo-orchitis usually responds well to appropriate antibiotic therapy, although progression to testicular infarction is possible. Conclusion Clinical presentation of persistent scrotal pain and oedema in cases of epididymo-orchitis should raise strong suspicion of testicular ischemia or infarction. Despite all efforts, progression to bilateral testicular infarction resulting in castration is a possible catastrophic outcome.