A 68-year-old patient with a history of severe mental retardation and deafness secondary to meningitis in childhood.
She presented to our emergency department with pain and inflammation in the left hemiscrotum of more than 3 weeks duration, which did not cease despite antibiotic treatment and antiscrotum.
On examination, a generalized increase in content and more pronounced on the left side was observed, with painful consolidation test, thickened epididymis surface and firm consistency.
The right testicle was normal.
Urine sediment revealed pyuria.
Ultrasound showed an enlarged, heterogeneous left test, with an area in medial position with multiple cystic cavities, some of them hypoechogenic.
Evolving orchitis was diagnosed and the patient was discharged with analgesic anti-inflammatory treatment.
Eight days later, the patient came for a review in the urology clinic, where the consolidation clearly defined a nodule, which suggested a differential diagnosis with testicular neoplasia.
A left radical orchiectomy was performed, after determination of tumor markers (b-HCG, alpha-fetoprotein and LDH), which were normal.
Macroscopically, the section surface of the orchiectomy specimen showed thickening of the tunica albuginea, with hemorrhagic zones.
Testicular parenchyma was increased in consistency, with presence of white fibrotic tracts and plaques.
Microscopic examination revealed hypospermatogenesis marked by hyalinization of the seminiferous tubules, as well as a chronic inflammatory process consisting of histiocytes, abundant plasma cells and giant cells.
Within some of these cells, the characteristic bodies of Michaelis-Gutmann with a "bud eye" appearance were recognized, which were positive for calcium MLP, thus suggesting its von Kos staining.
These inflammatory changes also partially affected the epididymis.
With the diagnosis of testicular and epididymal PLM, treatment was completed with a fluoroquinolone regimen for 3 months, after which the evolution is satisfactory and the patient is asymptomatic.
