Necrotising epididymo-orchitis with scrotal abscess

A 55-year-old man presented with a painful left scrotal enlargement and fever for 6 weeks. He was treated with antibiotics at the community hospital. His fever and scrotal pain were improved but the scrotum became enlarged. He was referred to our hospital to have testicular tumour ruled out. He had history of left renal calculi and urethral stricture with off and on urinary tract infection. Physical examination revealed left scrotal erythema with an enlarged, tender left scrotum. Laboratory investigations were notable for mild elevation of blood urea nitrogen 36 mg/dL (normal 7-24 mg/dL), and creatinine 1.7 mg/dL (normal 0.6-1.6 mg/dL). Urinalysis revealed cloudy urine with numerous white blood cells and red blood cells. Blood leucocyte count was 6.9 × 10 per dL with 59.6% neutrophils, 31.8% lymphocytes, and 3.5% monocytes. Urine culture showed no growth of organism. Scrotal ultrasonography (US) was performed. The patient underwent left orchiectomy. His post-operative period was uneventful. One month later, left nephrolithotomy was performed.