An Unusual Extrahepatic Manifestation of Acute Hepatitis B İnfection: Epididymitis

Abstract

Introduction: Numerous extrahepatic manifestations have been described in patients with acute viral hepatitis B. But just one report of co-existence of HBV infection and epididymitis was informed in the literature. In this report, we would like to present an adult male patient with epididymitis that might be related to acute hepatitis B. Case report: A 28-year-old man was directed to our hospital due to elevated liver enzymes. On his admission to us he had a history of scrotal swelling and pain for 6 days. Physical examination was unremarkable except for left scrotal swelling and left ankle eudema. On laboratory studies, liver enzymes (ALT, AST) were elevated 50-fold, total bilirubin:2.5 mg/dl, prothrombine time and blood counts were normal, HBsAg, HBeAg and anti-HBc-IgM were positive. Serological parameters of hepatitis A, C, D, CMV, EBV, mumps, VDRL, Anti-HIV 1/2 were negative. Urology consultation was performed and the patient was diagnosed acute epididymitis by urologic examination and scrotal color Doppler ultrasonography. Microscobic examination and culture of urine and urethral discharge (for C. trachomatis, N. gonorrhoeae) were negative. Standard tube agglutination test for brucellosis, tuberculin skin test, ANA, Anti-ds DNA were found negative. Scrotal swelling, ankle eudema and liver enzymes were disappeared two weeks later. Liver enzymes were reduced in a month. Conclusion: The most commonly described extrahepatic manifestations of hepatitis B are skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis. The cause of these findings is generally believed to be immune mediated. In this patient both arthritis and epididymitis were found. The patient is the second case was informed epididymitis as extrahepatic manifestation. The physician should also evaluate the patient for any extrahepatic manifestation while treating hepatitis B infection.