Acute Scrotum: An Unusual Presentation of Non-gonococcal /Non Specific Urethritis, Epididymitis and Orchitis (PART II)

Acute scrotum, an unusual manifestation of non-gonococcal urethritis (NGU), epididymitis and orchitis, in a middle aged man is described with cardinal clinical features characterizing it as a syndrome. Investigations were corroborative to conform to non sexually transmitted disease. E. Coli, sensitive to levofloxacin, was recovered on culture, which showed an affirmative response to levofloxacin intravenous infusion, uriliser and urispas. *Corresponding Author: Virendra N Sehgal, Department of Dermatology and Venereology, All India Institute of Medical Sciences and Research, New Delhi, India. Tel: 91-11-2767-0373;Fax: 91-11-2767-0373; E-mail: [email protected] Citation: Sehgal, V.N., et al. Acute Scrotum: An Unusual Presentation of Non-gonococcal /Non specific Urethritis, Epididymitis and Orchitis (PART II). (2015) Invest Dermatol Venereol Res 1(2): 2224. Acute Scrotum: An Unusual Presentation of Non-gonococcal /Non Specific Urethritis, Epididymitis and Orchitis (PART II) Virendra N Sehgal*, Naresh Sehgal, Ruchi Sehgal, Jangid B. Lal Received date: September 12, 2015 Accepted date: September 23, 2015 Published date: September 28, 2015 DOI: 10.15436/2381-0858.15.009 Figure 2: Acute Scrotum displaying erythema, edema and swelling of the scrotum skin confined to left side. Investigations Gram-stained smear prepared from urethral discharge from urethra was negative for gram-negative intra-and extra cellular diplococci, the Neisseria gonorrhoeae. Venereal disease research laboratory (VDRL) test was non-reactive. Human immunodeficiency virus (HIV) was negative. Culture and Sensitivity Escherichia Coli (E.Coli) was recovered from the urethral discharge / urine examination on culture on LB broth (Sigma-Aldrich). It was found to be sensitive to Co-trimoxazole, chloramphenicol, tetracycline, nitrofurantoin, Levofloxacin, azithromycin, amikacin, ceftizoxime, piperacillin/tazobactum and imipenem. Culture for Chlamydia trachomatis did not yield any growth on transport media. Ultrasonography[7] High resolution ultrasonography of the testis was performed to evaluate its status, using high frequency 11Mhz (MegaHertZ) linear probe; the left testis was normal in size, shape and echo-pattern. Loculated fluid was seen in tunica vaginalis with multiple thin septations. Left spermatic cord was thickened and heterogeneous. Increased vascularity was conspicuous (funiculitis). Left epididmymis size was enlarged, hypo-echoic with increased vascularity. No evidence of dilated veins was seen. Right testis was normal. Treatment Levofloxacin (Levotas) 0.5 % W/v in 500 mg/100 ml infusion by slow intravenous (I.V) infusion, BDS, twice daily for ten injections spread over period of 5 days. This treatment was supplemented by oral administration of uriliser (Citric acid/ sodium citrate and potassium citrate) 5 ml twice a day, and urispas (Flavoxate HCl) in dosage of 200 mg twice a day for 5 days. The response to the treatment was evident by slow regression of symptoms and signs during the followup period.