Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient

Abstract

Study design: A case report of xanthogranulomatous funiculitis and epididymo-orchitis. Xanthogranulomatous in¯ammation is an uncommon, non-neoplastic process characterised by destruction of tissue, which is replaced by a striking cellular in®ltrate of lipid-laden macrophages. Case report: A 21-year male sustained complete tetraplegia at C-6 level, after a fall in 1998. The neuropathic bladder was managed with an indwelling urethral catheter. He had many unsuccessful trials of micturition. Sixteen months after the cervical injury, he noticed swelling of the left side of the scrotum following removal of a blocked catheter. He was prescribed antibacterial therapy. Four weeks later, physical examination revealed a hard and irregular swelling encompassing the testis, epididymis and spermatic cord. The clinical diagnosis was epididymo-orchitis progressing to pyocele. Through a scrotal incision, the swollen testis, epididymis and diseased segment of the spermatic cord were removed en masse. Histopathology showed extensive areas of necrosis, with xanthogranulomatous in¯ammation in the spermatic cord and to a lesser extent in the testis/epididymis. Conclusion: Repeated episodes of high-pressure urinary re¯ux along the vas deferens during dyssynergic voiding, and subsequent interstitial extravasation of urine together with chronic, low-grade, suppurative infection possibly led to development of xanthogranulomatous in¯ammation in the testis and the epididymis. Since tissue destruction is a feature of xanthogranulomatous in¯ammation, the de®nite and curative treatment is either complete (or, where applicable, partial) excision of the a ected organ in most of the cases. Spinal Cord (2000) 38, 769 ± 772

Three cases of xanthogranulomatous epididymitis caused by E. coli

“…Of 19 xanthogranulomatous funiculitis and orchitisepididymitis cases, including ours, seven cases were associated with diabetes, 1,7,10,11 three cases with spinal injury or neuropathic bladder, 7,8,10 and four cases with benign prostatic hyperplasia and/or surgical intervention. 9,10 More than two-thirds of the cases were related to mechanical or functional obstruction in the spermatic tract, and/or to stasis of possibly infectious agents.…”

Xanthogranulomatous orchitis with scrotal fistulas

“…3 Genital system involvement, such as epidymitis or funiculitis with orchitis, are also very rare. 3,4 Reflux of urine to the seminal vesicles or vas deferens and urethral manipulation (catheterization or surgery) were reported as possible risks for the development of the inflammation. 3,4 The present case was unrelated to the above-mentioned conditions.…”

“…3,4 Reflux of urine to the seminal vesicles or vas deferens and urethral manipulation (catheterization or surgery) were reported as possible risks for the development of the inflammation. 3,4 The present case was unrelated to the above-mentioned conditions. Further investigation of the pathogenesis of xanthogranulomatous infection in the urological field may be necessary.…”

“…Urine and pus cultures were negative. Laboratory results included a white blood cell count of 11 ¥ 10 9 /L, a hemoglobin level of 13.8 g/dL and a platelet count of 407.000/mm 3 . Tumor markers aFP, bHCG and LDH were normal.…”

An Unusual Case of Extensive Xanthogranulomatous Orchitis in a Diabetic Patient

“…Testicular involvement is a rare event, with 13 cases reported to date [1][2][3][4][5][6][7] . We present an unusual case of extensive xanthogranulomatous orchitis (XGO) and discuss the possible role of diabetes mellitus in the pathogenesis of this unusual lesion.…”