Objective: To emphasize the need to consider Brucella infection in patients presenting with acute scrotum of a possible inflammatory etiology, in endemic areas, as in some Spanish regions. The abscess forming type, although rare, should be considered. One such case is described herein and the literature briefly reviewed.
Methods: A male patient consulted for subacute inflammation and left testicular pain. He had systemic brucellosis four months earlier that had completely remitted following specific therapy. The patient had a physical examination, analytical, blood and urine analyses, specific serological tests and testicular ultrasound evaluation.
Results: Physical examination disclosed left testicular pain and inflammation suggesting epididimo-orchitis. The laboratory findings were normal except for high titles against Brucella. Ultrasound disclosed diffuse enlargement of the left testis with several well-defined hypoechoic areas. The foregoing data suggested abscess forming orchitis, although a neoplasm could not be discarded. Empirical antibiotic therapy was instituted initially and specific therapy for Brucella was administered subsequently, but unilateral orchidectomy was decided because of the poor response to therapy. Histopathological analysis of the surgical specimen disclosed acute abscess forming epididimo-orchitis with multifocal chronic granulomatous involvement.
Conclusion: Brucella epididimo-orchitis must be considered when making the differential diagnosis in acute inflammatory scrotum, particularly in endemic areas, even in the absence of suggestive clinical and/or US findings. Necrotizing orchitis is a rare form of Brucella infection which must be distinguished from necrotizing involvement arising from other pathogens (TB or Salmonella). Above all, this condition must be distinguished from a tumor.