WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Kirtick Poovendran, Sidra Izhar, Mohammad Ibrahim Hashmi, Nalin Aaditya Dharmalingam,
Patel Rushi Kalpeshkumar

ABSTRACT

Background: Epididymo-orchitis (EO) is an acute inflammation of the epididymis and testis, which results in acute scrotal pain in adult men. It is caused by bacterial spread from the lower urinary tract through the vas deferens to the epididymis and testis. Men aged under 40 years are frequently present with sexually transmitted infectious agents like Chlamydia trachomatis and Neisseria gonorrhoeae, whereas men aged above 40 years usually develop EO due to enteric gram-negative organisms, mainly Escherichia coli. Diabetes mellitus is considered to be a risk factor due to impaired immune defenses and an increased chance of urinary tract infection. Doppler ultrasound is used to confirm the diagnosis and remove the need for surgical conditions like testicular torsion. Case Presentation: We describe a case report of a 64-year-old male with long-standing uncontrolled diabetes who presented with a 10-day history of progressively worsening left-sided hemiscrotal pain, swelling, and intermittent low-grade fever. On physical examination, the patient revealed left scrotal tenderness, swelling, and testicular tenderness. Urinalysis and culture were negative. Doppler ultrasound findings supported left-sided epididymo-orchitis and excluded torsion, hernia, and other acute scrotal pathology. Laboratory results showed uncontrolled elevated blood glucose levels. Management and Outcomes: The patient was hospitalised, and broad-spectrum IV antibiotics were considered based on his age, suspected gram-negative infection, and high-risk diabetic status. The antibiotic regimen covered a broad range of enteric and anaerobic organisms. Supportive treatments such as scrotal elevation, analgesics, and intensive insulin therapy to restore glucose levels. The patient showed consistent improvement with a reduction in scrotal swelling, cord tenderness, fever resolved ,and glycemic levels improved to the target range. By day 8-10, he was clinically stable and discharged on oral clindamycin, linezolid, pantoprazole, and continuation of insulin therapy, with diabetic dietary advice. Discussion: This case highlights the presentation and management of EO in an older diabetic man. The gradual onset of pain, unilateral swelling, and low-grade fever were classic signs, differentiating the testicular torsion, which presents with sudden, severe pain. The risk of infections and complications like abscess formation and infarction is highly related to the uncontrolled diabetes of the patient. Administering broad-spectrum antibiotic therapy and strict blood glucose management were essential in the patient’s improvement. Most patients recover fully, but recurrence and complications can happen more often in diabetics and need strict follow-up. Conclusion: Early correct diagnosis, appropriate antibiotic therapy covering enteric organisms, excluding testicular torsion by Doppler imaging, and glycemic control are musts in managing the epididymo-orchitis in older diabetic patients. This case highlights the need to identify high-risk patients early to decrease complications and ensure healthy recovery.