A Rare Case of Bilateral Testicular Abscess Secondary to Acute Epididymo-Orchitis

Abstract

Acute epididymo-orchitis is a common inflammatory condition that usually responds to antimicrobial therapy; however, delayed diagnosis or inadequate treatment may lead to testicular abscess formation. Bilateral testicular abscess is exceptionally rare. A 38-year-old man presented with a 2-month history of bilateral testicular pain and swelling, more pronounced on the left, together with burning micturition, a poor urinary stream, straining during urination, and intermittent fever with chills. He had previously undergone drainage of a right scrotal abscess. Examination showed bilateral scrotal swelling, loss of rugosities, increased local temperature, marked tenderness, and enlarged, firm, fluctuant testes. Routine laboratory findings showed no major abnormality. High-resolution ultrasonography demonstrated bilateral acute epididymo-orchitis with evolving testicular abscesses, greater on the left, a complicated left septated hydrocele, and diffuse left scrotal wall oedema with abscess formation. Urological assessment raised the possibility of an underlying urethral stricture predisposing to recurrent infection. The patient received intravenous meropenem and amikacin and showed gradual clinical improvement during hospitalisation without orchiectomy. This case demonstrates that bilateral testicular abscess may complicate acute epididymo-orchitis and may occur in association with lower urinary tract symptoms and recurrent scrotal infection. Early ultrasonographic assessment and prompt antimicrobial treatment were central to diagnosis and conservative management in this patient, with preservation of both testes.