案例報告: 免疫健全年輕男性突發性急性輸精管發炎

蘇奕瑋、張東平、薛又仁、黃建榮、賴昱維、蕭毅君、李淑文、陳修聖、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科

A case report: Sudden onset acute vasitis in an immunocompetent young man

Yi-Wei Su, Tung-Ping Chang, Thomas Y. Hsueh, Andy C. Huang, Yu-Wei Lai, Yi-Chun Hsiao, Shu-Wen Li, Shiou-Sheng Chen, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction:

Vascitis, also known as deferentitis, is a rare disease often associated with urinary tract infections. Previous studies have indicated that risk factors include herniorrhaphy or prostatectomy, and possibly HIV infection. Symptoms may include inguinal pain, fever, or even a palpable inguinal mass. In this case report, we present the case of an immunocompetent 38-year-old man with acute vascitis and epididymitis who was successfully treated with empiric antibiotics.

Case presentation: 

A 38-year-old man had a medical history of herniorrhaphy for bilateral hernia for more than 10 years and left testicular torsion. He presented to our Genitourinary Outpatient Department (GU OPD) with a sudden onset of right testicular pain and right inguinal pain. Additionally, he had a fever exceeding 38°C. He denied recent sexual activity. The Prehn sign was positive. A scrotal echogram revealed right epididymitis and bilateral varicocele. Testicular blood flow was visible. Urine analysis showed pyuria and hematuria, suggesting a urinary tract infection. He was subsequently referred to the Emergency Room (ER) for further evaluation.

An abdominal CT scan revealed diffuse swelling of the right vas deferens with a 2.3x0.3 cm abscess in the inguinal region, consistent with vascitis. Bilateral hydrocele was also identified. He was admitted for antibiotic treatment with Levofloxacin. After 5 days of treatment, he was free from fever and pain and was discharged without complications.

Conclusion:

        Vascitis is a rare condition but should be considered in patients with fever accompanied by inguinal pain, especially if they have a history of herniorrhaphy or prostatectomy, or potential HIV infection. Initial treatment involves the use of empiric broad-spectrum antibiotics and symptomatic care. For patients who do not respond to conservative treatment, further measures such as abscess drainage or surgical debridement may be necessary. Follow-up for these patients is crucial.