Bilateral Epididymal Candida abscesses:Sonographic findings and sonographically guided fine‐needle aspiration

Abstract

ABSTRACT:We report the case of a 67-year-old diabetic man who presented 2 months after transurethral prostate surgery with impaired consciousness, urinary incontinence, and recurrent urinary tract infections that did not respond to antibiotic treatment. Sonographic findings suggested abscess formation (enlarged, heterogeneous epididymides and a central hypoechoic area in the head of the left epididymis). Aspirates obtained from sonographically guided needle biopsy were purulent. Staining showed budding yeast forms, and Candida albicans grew in culture. Systemic candidiasis was diagnosed. The patient underwent bilateral epididymo-orchiectomy, and pathologic analysis of resected specimens showed bilateral epididymal necrosis and disseminated abscess formation. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:413-415, 1998. Keywords: epididymis; epididymitis; candidiasis; ultrasonography; needle biopsy E pididymitis is a common genitourinary problem that is generally accepted and treated as a bacterial infection; however, a variety of microorganisms have been shown to be causative agents.1,2 Opportunistic infections of the epididymies are being seen more commonly and appear to be a growing problem because of the increasing number of patients who are immunocompromised owing to cancer therapy, transplantations, and the acquired immune deficiency syndrome.1-4 Sonography is the imaging modality of choice in cases of epididymitis because it can be used to demonstrate epididymal abscesses and to guide aspiration. We report a case of bilateral epididymal abscesses in which sonographically guided aspiration led to the diagnosis of systemic candidiasis. CASE REPORTA 67-year-old diabetic man was admitted to the hospital with impaired consciousness and urinary incontinence. A clinical history revealed that he had had transurethral prostate surgery 2 months previously and had had recurrent urinary tract infections ever since that were unresponsive to antibiotic treatment. On physical examination, he was found to have an indurated, red scrotum. Bilateral, soft, intrascrotal masses were palpable. Scrotal sonography, performed using a Sonoline SL 2 ultrasound scanner with a 7.5-MHz lineararray transducer (Siemens, Erlangen, Germany), demonstrated that both epididymides were enlarged and heterogeneous (Figures 1 and 2). The head of the left epididymis contained a central hypoechoic area (Figure 2). The sonographic findings were not specific but were highly suspicious for abscess formation. As a diagnostic aid, sonographically guided needle aspiration was performed on both sides with a standard 20-gauge hypodermic needle attached to a disposable syringe, without local anesthesia. Aspirated material (5 ml from the left and 2 ml from the right) was purulent, and staining showed budding yeast forms. Candida albicans grew in culture. A diagnosis of systemic candidiasis was suspected and confirmed by the demonstration of budding yeast forms in the blood and cerebrospinal fluid. MediCorrespondence to: M. Seçil

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“…Infection with Candida in the epididymis or prostate is uncommon, but may be associated with diabetes and indwelling urinary catheters [16][17][18].…”

Epididymitis and Other Inflammatory Conditions of the Male Excurrent Ductal System

“…However, aspiration of the epididymis may cause epididymal trauma and subsequent infertility. Another reason for being aggressive in diagnosing and treating opportunistic infection is that the local infection presented may be the early sign of systemic infection, which is highly lethal in this subgroup of patients (Secil et al, 1998).…”

Sonographic Features of Spermatic Cord Leiomyosarcoma

“…5 However, chronic epididymitis associated with granulomatous inflammation of tuberculosis, brucellosis, syphilis, and fungal infections or sarcoidosis can appear as epididymal masses having heterogenous echogenicity on sonography that may be indistinguishable from tumors. 8,9 Scrotal fluid collections and varicoceles may clinically appear as scrotal masses, but they rarely cause difficulties in sonographic diagnosis.…”