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Epididymo-orchitis and testicular abscess due to Nocardia asteroides complex

Jonathan C Routh1, Garrett H Lischer, Bradley C Leibovich

  • 1Department of Urology, Mayo Clinic, Rochester, Minnesota 55901, USA. routh.jonathan@mayo.edu

Urology
|March 23, 2005
PubMed

Insights

Nocardia asteroides complex, a rare pathogen, caused epididymo-orchitis in an immunosuppressed patient. Treatment involved surgery and sulfa therapy, crucial for survival in this severe infection.

Area of Science:

  • Infectious Diseases
  • Urology
  • Microbiology

Background:

  • Nocardia asteroides complex is an opportunistic pathogen primarily affecting immunocompromised individuals.
  • Epididymo-orchitis, inflammation of the testicle and epididymis, is a rare but serious condition.
  • This report details a unique case in a patient with immune-mediated vasculitis treated with immunosuppressive agents.

Observation:

  • A 78-year-old male presented with fever and weight loss.
  • Diagnostic workup revealed a testicular abscess.
  • The patient had recently undergone treatment with cyclophosphamide and prednisone for vasculitis.

Findings:

  • Surgical intervention (orchiectomy) was performed for the testicular abscess.
  • Cultures identified Nocardia asteroides complex as the causative agent.
  • Post-operative treatment included sulfa-based antibiotics.

Implications:

  • This case highlights Nocardia asteroides complex as a potential cause of epididymo-orchitis in immunosuppressed patients.
  • Aggressive surgical debridement and prolonged sulfa therapy appear critical for patient survival.
  • Early recognition and prompt treatment are essential given the historically high mortality rate associated with this infection.

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