Xanthogranulomatous epididymitis: a case report.
We report a case of bilateral scrotal masses in a diabetic man with bilateral epididymitis and abscess formation.
Epididymis↗
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The use of ketoconazole to treat systemic blastomycosis presenting as acute epididymitis.
We report on a patient with systemic blastomycosis who presented with acute epididymitis that was followed by the appearance of typical skin and pulmonary lesions. An excellent clinical response was obtained with ketoconazole, a new oral antifungal agent. Only 2 cases of systemic blastomycosis that were treated with ketoconazole have been reported and neither patient had genitourinary involvement. The diagnosis and treatment of systemic blastomycosis with genitourinary involvement, and ketoconazole as the treatment of fungal infections are discussed.
Antifungal Agents↗
Epididymitis in infancy.
The occurrence of epididymitis in infants suggests the presence of urinary infection and the likelihood of an associated structural genitourinary abnormality, requiring complete urologic investigation. The advent of testicular scanning and the ultrasonic stethoscope, coupled with an increased index of suspicion, makes possible the non-operative diagnosis and management of a condition usually made by surgical exploration.
Epididymitis↗
Post-transplant epididymitis and orchitis following Listeria monocytogenes septicaemia.
We report the occurrence of epididymitis and orchitis 1 week after the onset of Listeriosis in an 11-month-old boy receiving an orthotopic liver transplantation for biliary atresia. Immunologic implications of Listeria monocytogenes-induced testicular inflammation are discussed, and the potential role of immunosuppression with tacrolimus is also discussed.
Biliary Atresia↗
Structure and expression of the rat epididymal secretory protein I gene. An androgen-regulated member of the lipocalin superfamily with a rare splice donor site.
The complete rat epididymal secretory protein I (ESP I) gene was isolated from a genomic library constructed in bacteriophage lambda Charon 4A. The complete nucleotide sequence of the gene and its immediate 5' and 3' flanking sequences were determined. Interesting features include the presence of a rare, but functional, splice donor site (...GC) and the presence of a putative androgen-receptor-binding element. A detailed analysis of ESP I regulation was carried out after castration and subsequent testosterone treatment, demonstrating the requirement for androgens. Efferent-duct ligation and cryptorchism, on the other hand, had no effect on the steady-state concentrations of ESP I transcripts. Comparison of the exon/intron organization of the ESP I gene with those of members of the lipocalin superfamily provides strong support for a common ancestral origin.
Amino Acid Sequence↗
Acute epididymitis in children: a 4-year retrospective study.
OBJECTIVE: To evaluate the incidence of acute epididymitis (AE) compared to testicular torsion (TT) as a form of acute scrotum in children, to describe clinical aspects and to assess the value of laboratory tests and radiological investigations in AE. METHODS: Retrospective review of the medical records of 49 patients presenting with clinical aspects of AE over a 4-year period; evaluation of clinical features, laboratory tests (blood, urine), radiological examinations (duplex and real-time ultrasound, renal sonography, voiding cysturethrography [VCUG]) and urodynamics. RESULTS: 49 patients with an overall mean age of 9.8 years (range 0.2-15.3 years) presented with AE. In the same period, 31 subjects required surgery for TT. Local pain on palpation of the epididymis and spontaneous pain in the testis and/or epididymis were the most common clinical signs. In 2 patients, urine cultures revealed significant bacteriuria. Duplex and real-time ultrasound showed no false negative result. 41% of the patients revealed concomitant urological diseases, but only in 1 patient was treatment influenced by the uropathy. 16/21 older boys (76%) demonstrated normal uroflow patterns. CONCLUSION: AE seems to be more common than acute TT. Urinalysis and urine culture should be performed for all children with AE. High resolution ultrasound with an experienced investigator is able to exclude TT reliably so that routine surgical exploration is seldom necessary.
Acute Disease↗
A proposed mouse model for acute epididymitis provoked by genital serovar E, Chlamydia trachomatis.
This study was conducted to determine the efficacy of the male mouse as a model for epididymitis caused by human genital serovar E, Chlamydia trachomatis. C. trachomatis was reisolated from all tissues removed on Days 3, 5, and 7 post inoculation (pi). Although some infected epididymides removed on Days 10, 14, and 21 pi were positive, control tissues remained negative. Histopathology of tissues showed a heavy, mixed inflammatory infiltrate consisting of polymorphonuclear cells and lymphocytes. Serum antibody to C. trachomatis was detected in the infected mice only (titer greater than or equal to 1:32). Chlamydial inclusions and individual elementary bodies were confirmed by immunofluorescent and immunoperoxidase staining up to Day 7 pi. These data show that the male mouse is susceptible to C. trachomatis infection and is appropriate for studies dealing with the effect of C. trachomatis on male fertility.
Acute Disease↗
Granulomatous epididymal lesion of possible ischemic origin.
In a histologic review of adult epididymides obtained at autopsy (both epididymides of 408 men) or during surgery (261 men with testicular or epididymal nontumoral pathology), a peculiar granulomatous lesion was observed in two autopsy specimens (unilateral) and three surgical specimens. The lesion was located in the caput epididymidis and consisted of a zone of necrosis that involved efferent ducts and interstitial connective tissue and was not associated with an acute inflammatory response. Immunohistochemical study with anticytokeratin antibodies showed the presence of some epithelial cells in the damaged efferent ducts. At the periphery of the lesion, where damage was less severe, the efferent ducts only showed partial necrosis of their wall through which the necrotic material was released to the ductal lumen. Inflammatory infiltrates were scanty and consisted of lymphocytes and CD68-positive macrophages. Lymphocytes were mainly located around the necrotic zone or surrounding the adjacent, well-preserved efferent ducts, whereas macrophages formed large clusters in the ductal lumen. In these clusters, cholesterol crystals and giant cells of foreign body type were frequent. Intratubular epithelial regeneration as well as proliferation of small ducts showing epithelial regeneration and numerous spermatozoa in their lumen were observed. Ceroid granulomata, spermatic granulomata, and epidermoid metaplasia of the efferent ducts were observed in some cases. On the basis of the histologic study, the following developmental stages of the lesion are suggested: ischemic necrosis, granulomatous reaction, cicatrization, and sequelae. The term "granulomatous ischemic lesion" is proposed to designate this reactive lesion.
Adult↗
Testicular torsion versus epididymitis: a diagnostic challenge.
Unlike the patient who presents with a potentially acute abdomen, the child or adolescent with a potentially acute scrotum cannot simply be observed. If testicular torsion is present, the testicle must be detorted and orchiopexy performed as soon as possible for fertility to be maintained. Torsion of the appendix testis, however, can usually be managed without surgery. Since the presentations of epididymitis and testicular torsion overlap, it is sometimes difficult to rapidly make the correct diagnosis. Early genitourinary consultation is appropriate in this setting. Any patient in whom testicular torsion is strongly considered should undergo immediate exploratory surgery without diagnostic studies. If the findings overlap, immediate testicular radionuclide scanning should be arranged; alternatively, with experience, Doppler sonography can be carried out. If these radiographic studies cannot be arranged and interpreted within one to two hours, scrotal exploration should be performed. Any patient with an acute scrotal complaint and a negative scan should receive daily follow-up until the symptoms subside. Although our adolescent patient did well, his acute presentation and findings should have warranted immediate exploration. It is only through this aggressive approach that we can continue to increase testicular salvage rates.
Adolescent↗
Epididymal cysteine-rich secretory protein 1 encoding gene is expressed in murine hair follicles and downregulated in mice overexpressing Hoxc13.
Members of the Hox gene family of transcriptional regulators are believed to play essential roles in hair follicle differentiation, although little is known about the molecular mechanisms mediating these putative control functions. Transgenic mice overexpressing Hoxc13 in hair follicles (GC13 mice) exhibit complex phenotypic alterations including hair shaft defects and alopecia, as well as severe epidermal abnormalities. To identify some of the genetic pathways affected by Hoxc13 overexpression in hair, we performed large-scale differential gene expression analysis on the skin of 5-d GC13 versus normal FVB mice using DNA chip assays. A surprising result of these experiments was the identification of the epididymal cysteine-rich secretory protein 1 (Crisp1) gene as one of the genes with the greatest expression differential, in this case with greater than 20-fold downregulation in skin from GC13 mice. Crisp1 encodes a secreted protein that has originally been found to be abundantly expressed in the epididymis, where it plays a role in sperm maturation. We have localized Crisp1 mRNA in 5-d postnatal murine scapular skin by in situ hybridization, showing its expression to be restricted to the medulla of the hair shaft. Furthermore, we provide evidence for specific interaction of Hoxc13 with at least one cognate binding site found in the Crisp1 promoter region, thus supporting the concept of a Hoxc13/Crisp1 regulatory relationship. In summary, these data establish the hair as a novel site for Crisp1 expression where its functional role remains to be determined.
Animals↗
The frequency of Chlamydia trachomatis in acute epididymitis.
Twenty-five patients with bacteriologically proven epididymitis were studied between 1984 and 1986. Thirteen were less than 35 years old and in 11 of them Chlamydia trachomatis was isolated; of the 2 remaining patients Escherichia coli was found in 1 and Neisseria gonorrhoeae in the other. In patients more than 35 years old, gram negative bacteria were the cause of infection in 10 and only 1 case was attributable to Chlamydia trachomatis. These results suggest that Chlamydia trachomatis is much more frequent in men under the age of 35 and the difference is statistically significant.
Acute Disease↗
Androgen-regulated epididymal secretory proteins associated with post-testicular sperm development.
A considerable body of information has now been assembled with regard to the major androgen-dependent secretory proteins of the rat epididymis. The proteins have been purified, specific antibodies have been developed against them, and their primary structure has been determined from cDNA clones. The antibody and cDNA probes have, in turn, been used to study the androgenic regulation of the synthesis and secretion of the proteins, the distribution of the proteins in various tissues and animal species, and the association of the proteins with the sperm surface during epididymal maturation. Despite this intensive effort, the precise physiological functions of the proteins still remain obscure, although circumstantial evidence indicates that glycoproteins D and E may be associated with surface receptors responsible for gamete recognition. Elucidation of the physiological roles of the proteins is clearly the area that warrants the greatest attention in future work.
Androgens↗
Field evaluation of the gel diffusion test for the diagnosis of ram epididymitis caused by Brucella ovis.
A comparison was made with the microslide gel diffusion technique, the complement fixation test, cultural isolation, and clinical examination in detecting ram epididymitis caused by Brucella ovis. The results of the gel diffusion method are shown to be similar to those obtained by the complement fixation test and isolation of B. ovis from cultures of semen. The technique offers a reliable diagnostic method adaptable to field use in controlling ovine brucellosis and is more practical.
Animals↗
Serodiagnosis of ram epididymitis by counterimmunoelectrophoresis, using Brucella ovis surface R antigen.
The counterimmunoelectrophoresis (CIE) technique was developed as a diagnostic procedure for ram epididymitis caused by Brucella ovis. CIE test results with sera from naturally and experimentally infected male sheep compared favorably with those obtained by gel diffusion and complement fixation employing the same B. ovis surface R antigen. The main advantage of CIE over gel diffusion consists in a significant reduction of the time required to detect precipitin formation, whereas both methods obviate several of the difficulties encountered with complement fixation tests for B. ovis.
Animals↗
Characterization of Brucella ovis lipopolysaccharide and its use for diagnosis of ram epididymitis by enzyme-linked immunosorbent assay.
Rough lipopolysaccharide, extracted by a mixture of phenol, chloroform, and petroleum ether from freeze-dried Brucella ovis cells with a yield of 0.71%, contained relatively small amounts of protein and nucleic acid contaminants as compared with lipopolysaccharides from other Brucellae. The crude lipopolysaccharide was suitable as a diagnostic antigen in an enzyme-linked immunosorbent assay for the sensitive and specific detection of ram epididymitis caused by B. ovis infection. In comparative serological tests, the enzyme-linked immunosorbent assay with B. ovis lipopolysaccharide gave better identification of infections and fewer false-negative results than the enzyme-linked immunosorbent assay with sonicated antigen or the complement fixation test.
Animals↗
Amiodarone-induced sterile epididymitis.
Sterile epididymitis in 2 patients who were on amiodarone for cardiac arrhythmias is presented. Decrease in drug dosage rendered the patients pain-free and testicular swelling resolved in a fortnight.
Amiodarone↗
Epididymitis in children and adolescents on clean intermittent catheterisation.
The records of 119 children and adolescents on clean intermittent catheterisation (CIC) were reviewed to assess the incidence and predisposing factors, if any, of epididymo-orchitis. CIC had been performed for a total of 448 patient years with a mean of 4.5 years (range 3 months to 19 years). Of the evaluable 99 patients, 10 suffered attacks of epididymo-orchitis after commencing CIC. There was an equal incidence on both sides. Three patients had recurrent attacks. Epididymitis occurred at the rate of 1 episode for 10 patient years. Those who had neuropathic bladders and more than 2 symptomatic urinary tract infections annually had a higher incidence. Prophylactic antibiotics did not reduce the incidence but long-term specific antibiotic therapy may prevent further attacks. Vasectomy and orchidectomy had to be done in 2 patients for recurrent attacks and intractable sepsis.
Adolescent↗
Granulomatous epididymitis related to Rhodotorula glutinis infection in a dog.
A 4-year-old, male Great Dane dog developed severe swelling of the scrotum on 9 December 1991, and the testes and epididymides were removed surgically on 12 December 1992. The cut surface of the epididymides consisted of hard connective tissue and several small abcesses with slight hemorrhage. Histopathologically, the seminiferous tubules in the testes had only a few spermatogenic cells, but Sertoli cells were well preserved. Both epididymides consisted entirely of a proliferation of fibrous connective tissue, and only a few ducts deferens containing cell debris, neutrophils, and macrophages in the lumina were present. In all lesions of the epididymides, the macrophages contained periodic acid-Schiff- and Grocott's silver-positive round granules, 5-8 microns in diameter. Microbiologically, smooth salmon-pink colonies consisting of ovoidal yeast, about 10 microns in diameter, were isolated from the samples of epididymides but not from those of the testes. The isolated yeast had microbiological characteristics of Rhodotorula glutinis. From these observations, we diagnosed the present case as granulomatous epididymitis due to Rhodotorula infection.
Animals↗