由腮腺炎至急性陰囊疼痛：成人腮腺炎併發副睪睪丸炎病例報告

江冠億¹、林巧文¹、賴昱維¹、薛又仁²、陳修聖¹、邱文祥³

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²臺北市立聯合醫院和平婦幼院區 外科部 泌尿科；³新光醫療財團法人新光吳火獅紀念醫院 外科部 泌尿科

From Parotitis to Acute Scrotum: A Case of Adult Mumps Epididymo-Orchitis

Kuan-I Chiang¹, Chyau-Wen Lin¹, Yu-Wei Lai¹, Thomas Y. Hsueh², Shiou-Sheng Chen¹, Allen W. Chiu³

¹Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan; ²Division of Urology, Department of Surgery, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan; ³Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Case Presentation:

A 35-year-old South Korean male with a history of appendectomy initially presented with acute left parotid swelling, sore throat, and upper respiratory tract symptoms. He was diagnosed with tonsillitis at a local otolaryngology clinic and treated with antibiotics, with gradual improvement over three days.

On the third day, he developed progressive left scrotal pain and swelling and presented to the emergency department. Physical examination revealed marked tenderness of the left testis without obvious external abnormalities. Laboratory studies showed no pyuria, but leukocytosis with neutrophil predominance.

Color Doppler scrotal ultrasonography demonstrated increased vascularity of the left testis without a focal mass (Figure 1). Viral orchitis was suspected, and mumps serology revealed an elevated IgM titer. Empirical levofloxacin was initiated for possible bacterial epididymo-orchitis. Urine culture showed no bacterial growth. The patient improved with supportive care and was discharged in stable condition after six days.

Discussion and Conclusion:

Mumps orchitis is a recognized complication in post-pubertal males, occurring in 5–37% of cases. Testicular involvement typically develops 4–10 days after parotitis due to hematogenous viral spread, resulting in inflammation and edema of the testicular parenchyma.

In acute scrotal pain, prompt differentiation from testicular torsion is critical. Color Doppler ultrasonography is the imaging modality of choice, distinguishing inflammatory hypervascularity from the reduced or absent blood flow seen in torsion.

Management is mainly supportive, although empirical antibiotics may be considered when bacterial infection cannot be excluded. While the prognosis is generally favorable, potential complications such as testicular atrophy and subfertility should be considered.