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| CASE REPORT |
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| Year : 2022 | Volume
: 7
| Issue : 2 | Page : 134-136 |
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Right testicular pain and epididymo-orchitis caused by Enterobius vermicularis
Mohammed Alorini
Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah; Department of Pathology, King Fahad Specialist Hospital, Buraydah, Qassim, Kingdom of Saudi Arabia
| Date of Submission | 01-Oct-2022 |
| Date of Decision | 16-Oct-2022 |
| Date of Acceptance | 25-Oct-2022 |
| Date of Web Publication | 27-Dec-2022 |
Correspondence Address:
Dr. Mohammed Alorini
Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah
Kingdom of Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/KKUJHS.KKUJHS_32_22
A rare case of epididymo-orchitis due to nematode infection by Enterobius vermicularis is reported. A 38-year-old male presented with right testicular pain. He was diagnosed with acute right epididymo-orchitis. Right epididymo-orchiectomy was performed. Microscopic examination showed parts of the body of the oxyurid in one section, thus confirming the diagnosis of pinworm infection. Although ectopic pinworm infections are broadly reported, testicular involvement is very rare. To our knowledge, this is the third reported case in the literature.
Keywords: Enterobius vermicularis, epididymo-orchitis, pinworm, testicular pain
How to cite this article:
Alorini M. Right testicular pain and epididymo-orchitis caused by Enterobius vermicularis. King Khalid Univ J Health Sci 2022;7:134-6 |
How to cite this URL:
Alorini M. Right testicular pain and epididymo-orchitis caused by Enterobius vermicularis. King Khalid Univ J Health Sci [serial online] 2022 [cited 2023 Mar 22];7:134-6. Available from: https://www.kkujhs.org/text.asp?2022/7/2/134/365760 |
| Introduction | |  |
Enterobius vermicularis (EV) is among the most prevalent nematode infections worldwide.[1]
It used to be called Oxyuris vermicularis. The only species that can transmit this parasite is humans. Children and their caregivers are the most susceptible group.[2] Overcrowding and poor hygiene contribute to the spread of infection. The most common mode of transmission is fecal–oral route. They can also be spread indirectly through food, clothing, bedding, and other objects. Ingested eggs hatch out in the stomach or at the beginning of the small intestine. After that, during the maturation stage, they travel to the colon. Finally, gravid females move to the perianal area to lay eggs during the night.[1],[2] Although EV infection may be asymptomatic or present with minor symptoms, it can less commonly cause serious morbidities such as urinary tract infection, appendicitis, salpingitis, endometritis, and pyelitis. It has also been detected in the breast, lung, liver, spleen, and Meckel's diverticulum.[3] Epididymal and testicular infestation by EV is unusual. Indeed, only two cases of epididymitis caused by EV were reported.[3],[4] Herein, we report a case of epididymo-orchitis caused by EV infection.
| Case Report | | |
A 38-year-old male, of Indian origin, previously healthy, presented to the emergency department complaining of right testicular pain. On physical examination, the right testicle was tender with a slight enlargement of the scrotum. Other systems were unremarkable. Testicular ultrasound examination revealed multiple abscesses and testicular ischemia on the right side. After taking the patient consent, a right epididymo-orchiectomy was performed. The specimen was received fixed in formalin measuring 11 cm × 6.3 cm × 4.7 cm. The cut section shows whitish-tan area of 3.7 cm × 3.3 cm [Figure 1]. Four representative sections were submitted. Microscopic examination shows mixed acute and chronic inflammation associated with abscess formation, destroying the testicular parenchyma and extending to the epididymis. In one of the sections, parts of the body of the oxyurid were seen [Figure 2]. Focal normal testicular tissue was observed. Granuloma formation was not seen. There was no evidence of malignancy.
| Discussion | | |
In most cases, pinworm infection is asymptomatic. On the other hand, certain patients, especially children, may develop perianal pruritus, insomnia, irritability, and restlessness.[1] Pinworms are usually limited to the gastrointestinal tract, but they can spread to the genitourinary tract, causing pyelitis, ureteritis, salpingitis, endometritis, and in rare cases, epididymitis. Only two documented cases of epididymitis due to pinworm infection were found in the literature.[3],[4]
Kollias et al.[3] described a case of a 52-year-old man with 1-month persistent swelling in his right epididymis despite antimicrobial treatment. The patient was medically free with no previous surgeries. However, 6 years before presentation, he received a medication to treat a urinary pinworm infection. Due to the swelling and constant pain in the right inguinal region, the right epididymis was resected. Histopathological analysis revealed foci of granulomatous inflammation containing one or more male pinworms on transverse section.
Sinikumpu and Serlo[4] reported a case of an 11-year-old boy who presented with acute left-side scrotal pain. During the physical examination, pain was found to be located above the testicle. Blood tests and urine culture were normal. Urgent testicular exploratory surgery was done and he was diagnosed with epididymitis. He was released home with empirical antibiotic prescription. After 4 months, the patient returned with right-side scrotal pain. Laboratory and radiological investigations were normal except for nonspecific scrotal concretions. Due to the intensity of the pain, urgent testicular exploratory surgery was performed again with no significant findings. After a month, the patient was admitted due to abdominal pain. Appendicitis was suspected and urgent laparotomy was done. Histopathological analysis revealed numerous pinworms in the appendiceal lumen. Appropriate antimicrobial was prescribed and eradication of the infection was ensured. The patient remained symptoms free during several months of follow-up. Although there was no histological confirmation of the presence of pinworms in the epididymis, the presence of pinworms in the appendix and the nonspecific scrotal concretions on radiology suggest that the epididymitis was caused by EV infection.
In our case, the presentation was acute with radiological confirmation of multiple abscesses and ischemia in the right testicle, for which the emergency resection was necessary. After resection, histological confirmation of pinworm infestation was made. Due to the acute presentation, the possibility of testicular parasitic infection was not raised during clinical evaluation. Perhaps the operation could have been avoided and a prescription of antiparasite medications would have cured the patient.
| Conclusion | | |
Our patient presented with a testicular pain, for which the exact etiology was not considered in the differential diagnosis. After unilateral epididymo-orchiectomy was performed, histological examination revealed parts of the body of the oxyurid confirming the testicular involvement by pinworm infection.
Availability of data and material
Data can be provided by the corresponding author upon request.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.
Acknowledgment
The author would like to thank Dr. Saroona Haroon for reviewing the manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Fan CK, Chuang TW, Huang YC, Yin AW, Chou CM, Hsu YT, et al. Enterobius vermicularis infection: Prevalence and risk factors among preschool children in kindergarten in the capital area, Republic of the Marshall Islands. BMC Infect Dis 2019;19:536.  |
| 2. | Wendt S, Trawinski H, Schubert S, Rodloff AC, Mössner J, Lübbert C. The diagnosis and treatment of pinworm infection. Dtsch Arztebl Int 2019;116:213-9. |
| 3. | Kollias G, Kyriakopoulos M, Tiniakos G. Epididymitis from Enterobius vermicularis: Case report. J Urol 1992;147:1114-6. |
| 4. | Sinikumpu JJ, Serlo W. Persistent scrotal pain and suspected orchido-epididymitis of a young boy during pinworm ( Enterobius vermicularis) infection in the bowel. Acta Paediatr 2011;100:e89-90. |
[Figure 1], [Figure 2]
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