To improve understanding and awareness of testicular infarct as a potential complication of epididymo-orchitis.

Case 1 A 27-year-old male presented with a history of dysuria and left testicular pain, redness and swelling, blood in ejaculate, having unprotected intercourse one week prior. He was clinically diagnosed with epididymo-orchitis and commenced on antibiotic therapy. He represented two days later with no improvement of symptoms. Ultrasound (US) at the time showed only features of non-complicated epididymitis. He was discharged home with a course of antibiotics. One month later, the patient represented with recurrence of his symptoms. Ultrasound then showed an enlarged left...

Epididymo-orchitis (EO) is the most common cause of acute scrotal pain (1). The incidence of EO in the United kingdom outpatient population is approximately 2.45 per 1000 men (2). Testicular infarction following EO is known albeit rare complication, with only a handful of case reports available. One centre in the USA reported a prevalence of 1.3% (6/462) over a 10 year period. Non-resolving infection despite appropriate antibiotic therapy, worsening of acute scrotal pain, recurrent EO, and abscess development likely contribute to a poorer prognosis (3)....

Testicular infarction as a result of EO is a rare but documented event. High clinical suspicion with atypical clinical evolution should warrant further assessment with scrotal US.

Lorenzo L, Rogel R, Sanchez-Gonzalez J, Perez-Ardavin J, Moreno E, Lujan S et al. Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs. Urology. 2016;94:36-41. Nicholson A, Rait G, Murray-Thomas T, Hughes G, Mercer C, Cassell J. Management of epididymo-orchitis in primary care: results from a large UK primary care database. British Journal of General Practice. 2010;60(579):e407-e422. Fehily S, Trubiano J, McLean C, Teoh B, Grummet J, Cherry C et al. Testicular loss following bacterial epididymo-orchitis: Case report and...