許家豪, 蔡德甫, 黃一勝

新光醫療財團法人新光吳火獅紀念醫院

Chia-Hao Hsu, Te-Fu Tsai, Thomas I-sheng Hwang

Division of Urology, Department of Surgery

Shin Kong WHS Memorial Hospital

 

Epididymitis generally comes from sexual transmission or urinary tract ascending infection. We present a case of a 39-year-old man admitted with right scrotal swelling. Scrotal ultrasonography revealed markedly increased right epididymal blood flow with compressive right testicular hypoperfusion. Right scrotal incision and debridement was performed. The patient’s clinical state did not improve after antibiotic treatment and wound care. Then he discharged against our medical advice. Two weeks later, he went to our emergent department with high fever and odor wound discharge. Computed tomography of abdomen and pelvis showed multifocal abscess within left psoas muscle. Aggressive intravenous fluid supplement with empirical antibiotic treatment was used. Scotal wound exploration found enlarged epididymis with nonviable right testis and then orchiectomy was performed. Blood culture and CT-guided aspirate (left psoas muscle abscess) culture all revealed methicillin-resistant staphylococcus aureus (MRSA) and we shifted the antibiotic to teicoplanin. His clinical state significantly improved and and was discharged from the hospital. Additional history revealed that he had been addicting heroin for a number of years.

  This case illustrates the potential for severe epididymitis with intravenous drug abuse and the value of a complete history. According to on-line literature search, the patient may be the first reported case of MRSA-induced epididymitis from hematogenous spreading due to intravenous drug abuse. The pathogen was not the main target of empiric antibiotic treatment. The infection progressed and resulted in testicular loss and psoas muscle abscess. Clinicians should be aware that clinical state not improved after empiric treatment need further investigation.