CHRISMED Journal of Health and Research

CASE REPORT
Year
: 2015  |  Volume : 2  |  Issue : 4  |  Page : 376--378

Testicular abscess as an unusual presentation of Salmonella typhi


Sophia Garg1, Francis Katumalla2, Amit Tuli2, Kim Mammen2,  
1 Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Urology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Correspondence Address:
Francis Katumalla
Department of Urology, Christian Medical College and Hospital, Ludhiana - 141 008, Punjab
India

Abstract

Salmonella is a large genus of Gram-negative bacilli within the family Enterobacteriaceae. It commonly causes infection involving the intestine as well as extraintestinal organs such as meninges, lungs, urinary tract, bones, and vessels, however, it rarely involves the genitalia. Review of literature shows only a few case reports of bacteriologically proven testicular abscess, most commonly due to nontyphoidal Salmonella. We report a case of a 68-year-old gentleman with testicular abscess due to Salmonella typhi with no systemic signs and symptoms.



How to cite this article:
Garg S, Katumalla F, Tuli A, Mammen K. Testicular abscess as an unusual presentation of Salmonella typhi.CHRISMED J Health Res 2015;2:376-378


How to cite this URL:
Garg S, Katumalla F, Tuli A, Mammen K. Testicular abscess as an unusual presentation of Salmonella typhi. CHRISMED J Health Res [serial online] 2015 [cited 2019 Sep 23 ];2:376-378
Available from: http://www.cjhr.org/text.asp?2015/2/4/376/165746


Full Text

 Introduction



Salmonella is a large genus of Gram-negative bacilli within the family Enterobacteriaceae. It has over 2500 serotypes and more than 200 serotypes are pathogenic to humans, in whom they cause a wide spectrum of illness from gastroenteritis to localized infections and/or bacteremia.[1] While Salmonella typhi and Salmonella paratyphi cause systemic illness, the vast majority of pathogenic Salmonella strains cause gastroenteritis and others localized infections. Here, we report a case of localized testicular infection caused by Salmonella typhi: An unusual mode of presentation and emphasize the importance of the microbiological investigation in such cases.

 Case Report



A 68-year-old gentleman, a known case of Parkinsonism and type 2 diabetes mellitus since 5–6 years presented with complaints of swelling and pain in the left hemiscrotum for 10 days. He had a history of lower urinary tract symptoms and low-grade fever since 15 days. The fever subsided with antipyretics but recurred again. There is no history of contact with a typhoid case/carrier.

On examination, his vital signs were within normal limit. He had pin rolling tremors while the rest of the systemic examination was normal. Local examination revealed approximately 8 cm × 8 cm swelling in left hemiscrotum with normal overlying skin. It was firm, fluctuant, and tender on palpation. Regional lymph nodes were not palpable. His routine hematological and biochemical parameters were normal. Urine routine showed 1–2 pus cells. Urine culture and blood culture revealed no growth. Stool routine examination was normal. Ultrasound of the scrotum revealed 6.8 cm × 6.1 cm ill-defined heterogenous mass in left scrotal sac [Figure 1]. Left testis was visualized separately while left epididymis was not separately visualized. Magnetic resonance imaging (MRI) pelvis showed a bilobed peripherally enhancing paratesticular lesion involving left scrotal sac [Figure 2].{Figure 1}{Figure 2}

Keeping the possibility of a paratesticular tumor/abscess, tumor markers were sent which were normal. Patient was taken up for surgical exploration. It was primarily a testicular abscess, which had ruptured into the scrotum and presented as a paratesticular swelling. Approximately, 100 ml of pus and debris was drained. He underwent incision and drainage of the abscess along with left orchidectomy, and the wound was left open. Pus was sent for microbiological examination. It was negative for acid fast bacilli but found to be growing Salmonella typhi sensitive to ampicillin, gentamycin, netromycin, ciprofloxacin, ceftriaxone, piperacillin/tazobactam. Histopathology report of left testis showed it to be an acute on chronic inflammation with abscess formation. No evidence of granulomatous or neoplastic pathology was found. He was initially started on intravenous piperacillin/tazobactam, which was continued for a week and then switched to oral ciprofloxacin for another 2 weeks. His scrotal wound was managed with saline dressings twice a day [Figure 3]. He was taken up for secondary suturing 3 weeks later [Figure 4]. He responded to this management and is doing well now.{Figure 3}{Figure 4}

Salmonella is a common infection involving the intestine as well as extraintestinal organs; however it rarely involves the genitalia. The clinical spectrum of presentation of Salmonella infection has widened as increasing reports are being published about the unusual forms of presentation. Extraintestinal complications occurring with Salmonella typhi infection include the involvement of central nervous system (3–35%), pulmonary (1–86%), bone and joints (≤1%), hepatobiliary system (1–26%), genitourinary system ([2] Testicular abscess by Salmonella typhi is a very rare condition. In a review of more than 700 cases of extraintestinal Salmonella infections by Cohen et al., only 1.4% cases were found to present as epididymo-orchitis.[3] In another study by Lalitha et al., in which a total of 6250 cases were reviewed, there were 100 cases with focal pyogenic infection and only one case of epididymo-orchitis with loculated Salmonella infection.[4] There have been few other isolated reports on this unusual mode of presentation.[5]

In our patient, there were no signs of acute inflammation and blood parameters were within normal limits. Ultrasound scrotum and MRI pelvis also suggested the possibility of a paratesticular neoplastic pathology, which was ruled out subsequently. It was only after pus culture and sensitivity report that Salmonella typhi was discovered to be the causative organism. Such presentations usually cause a diagnostic delay and can lead to severe morbidity, especially in a young patient. Here, it was primarily a testicular abscess that had ruptured into the scrotum and presented like a paratesticular lesion. It should be kept in mind that Salmonella can present in an unusual manner and at unusual sites. There should be a high index of suspicion for early diagnosis, especially in areas where typhoid is endemic. Clinical signs may not be convincing, and a complete workup is necessary. This article highlights the role of microbiological investigation in identifying the causative organism and confirming the diagnosis. Hence, for best surgical practice and rational use of antibiotics, any purulent material drained should be sent for microbial investigation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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