COVID-19 引起之副睪炎個案報告及文獻回顧

洪健哲 蔡樹衛

國泰綜合醫院 外科部 泌尿科

COVID-19 Epididymitis: Case report and review of the literature

Chien-Che Hung, Shu-Wei Tsai

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Acute epididymitis is characterized by pain, swelling, and inflammation of the epididymis that lasts less than 6 weeks. In men younger than 35 years of age, epididymitis is often caused by C. trachomatis or N. gonorrhoeae. Enteric organisms (Escherichia coli, Pseudomonas) may be present among MSM who are the insertive partner during anal intercourse.

We present a case of a 32-year-old male without any medical history before. He initially came to our emergency department for right scrotal swelling with local tenderness for 10 hours. He denied any traumatic history, fever episode, abnormal urethral discharge, unprotected sexual intercourse, inguinal protruding mass, or operation history. Physical examination revealed a right hard epididymal mass lesion with local tenderness, positive cremaster reflex, and positive Prehn’s sign. Urine analysis showed no pyuria or bacteriuria. Urine culture revealed negative findings. Scrotal ultrasonography demonstrated enlarged right epididymis with heterogenicity change and increased blood flow. Furthermore, he was diagnosed with COVID-19 infection a week before. Therefore, under the diagnosis of right epididymitis highly suspected secondary to COVID-19 virus infection, symptomatic medications and levofloxacin were prescribed. After one week, he returned to our outpatient department for further follow-up, and decreased size of the epididymal mass without local tenderness was further noted.

Acute epididymitis routinely presents as unilateral testicular pain and tenderness with a reactive hydrocele and palpable swelling of the epididymis. Urine bacterial cultures should be obtained in men with sexually transmitted enteric infections or gonorrhea infection, and in older men with epididymitis caused by genitourinary bacteriuria. Some case reports indicate that man was diagnosed with orchi-epididymitis and concurrent SARS-COVID infection, but without any respiratory tract symptoms. Hence, we herein report this atypical case to share our experience of diagnosis and management.