A 62-year-old male who came to the emergency department complaining of left testicular pain of 24 hours duration, accompanied by a temperature of 40oC, chills and accompanying voiding syndrome (dysuria).
During the anamnesis, the patient reveals his profession, veterinarian, a profession at risk for certain infectious diseases (brucelosis, trich and some parasitic diseases).
The examination showed a right test with normal characteristics, and the left test showed an increase in size as well as erythema and pain at the touch without fluctuation of the area affected although with pain to testicular mobilization.
The rectal examination showed no pathological findings and the abdominal examination as well as the renal percussion also ruled out accompanying affections as they were normal.
Analysis highlights leukocytosis of 22,240 with neutrophilia (neutrophils 90%).
Testicular ultrasound performed before admission showed homogeneous increases in the echogenicity of the affected testis, without involvement of the epididymis.
Soft tissue thickening with absence of testicular abscess.
Images compatible with orchitis without involvement of the epididymis.
The diagnosis of infectious orchitis was established and the patient was treated with antibiotic prescription consisting of Doxyacetate Imipenem and Temiplanin, together with corticosteroids and analgesic therapy.
Two days after admission, a new ultrasound was performed, showing an increase in homogeneous echogenicity similar to the contralateral echogenicity, and epididymal involvement.
Soft tissue thickening with absence of testicular abscess.
The syndromic picture ends up: Infectious orchiepididymitis.
In order to determine the cause of the pathology presented by the patient, it is necessary to carry out tests that allow knowing the causative germ.
The urine culture was negative, as well as the specific agglutination of Brucella.
However, seroagglutination of Rose Bengala is positive, as well as hemocultives, which are positive to Brucella spp. (the three).
Once the diagnosis of brucellar orchiepididymitis was confirmed, it was decided to maintain the treatment with Doxy and ciprofloxacin.
The patient evolved favorably with complete remission of symptoms.
