Testicular infarction in a patient with spinal cord injury with epididymitis: A case report

Abstract

Objective: To describe a case of epididymitis-related testicular infarction in a patient with spinal cord injury. Case report: A 22-year-old man with a traumatic spinal cord injury (American Spinal Injury Association Impairment Scale A; neurological level, C4) developed epididymitis during hospitalization. He presented with spiking fever, autonomic dysreflexia, and increased spasticity. Physical examination revealed a rapidly progressive, firm swelling of the right hemiscrotum; however, the patient had no subjective complaint of pain owing to a loss of sensation. Ultrasound showed right testicular infarction. The condition was successfully managed with conservative antibiotic treatment. Follow-up ultrasound at 6 months revealed atrophy of the right testis. Conclusion: Evaluating the progression of epididymitis is difficult in patients with a decreased or absent nociceptive perception, and depends on the patient's clinical course. We recommend close physical examination, including inspection and palpation, as well as greyscale and colour Doppler ultrasound scanning, to exclude the possibility of rare testicular infarction. Conservative treatment may be considered first.