Indian Pediatrics - Editorial

Case Reports

Indian Pediatrics 2007;44:699-700

Epididymoorchitis and Pancytopenia Caused by Brucellosis

Ekrem Guler
Selma Guler†
Hasan Ucmak*
Mustafa Gul**

From the Departments of Pediatrics, *Infectious Diseases, **Microbiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, and †Department of Infectious Diseases Kahramanmaras Yenisehir State Hospital, Kahramanmaras, 46050, Turkey.

Correspondence to: Dr. Ekrem Guler, Assistant Professor, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras 46050, Turkey. E-mail:[email protected]

Manuscript received: November 20, 2006; Initial review completed: February 15, 2007; Revision accepted: March 30, 2007.

Abstract:

A 15-year-old boy presented with fever and acute painful scrotal swelling. Complete blood count showed pancytopenia. Serum brucella antibodies were positive. Pancytopenia and epididymoorchitis are rare complications of brucellosis and clinicians must consider this entity in the differential diagnosis of adolescents with epididiymoorchitis associated with pancytopenia.

Key words: Brucellosis, epididymorchitis, pancytopenia.

Brucella is characterized by the classic triad of fever, arthralgia/arthritis and hepatosplenomegaly (1). Hematologic manifestations of brucellosis include anemia, leucopenia, thrombocytopenia and pancytopenia(2,3). We present a case with fever and acute painful scrotal swelling that was attributed to brucellosis.

Case Report

A 15-year-old boy presented with fever and painful scrotal swelling for 5 days. He gave a positive history of ingestion of unpasteurized fresh cheese. Physical examination revealed fever (39ºC), hepatosplenomegaly and left sided tender testicular swelling. The skin over the swelling was red with local rise of temperature. In ultrasonographic evaluation, the size of epididymis and peritesticular fluid were found to be increased bilaterally. Hemoglobin, white blood cell, neutrophil and plate-let counts were 9.9g/dL, 2300/mm3, 500/mm3 and 69000/mm3, respectively. Bone marrow aspiration specimens showed normocellularity and hemo-phagocytosis. C- reactive protein value was elevated up to 111 mg/dL. Erythrocyte sedimentation rate was 26 mm/hour. Serum brucella antibodies were positive at a dilution of 640 and blood culture was negative for Brucella. He was administered doxicycline and streptomycin. Epididiymoorchitis disappeared on the fourth day and pancytopenia improved in the third week of the treatment.

Discussion

Acute scrotal pain does not have an easily identifiable etiology and management can be difficult. The etiology of acute scrotal pain include acute epididymitis (43.0%), torsion of testicular appendage (40.6%), torsion of testis (11.7%) and other pathologies (4.7%)(4). Common causes of epididymoorchitis include mumps, E. coli, K. pneumonia, S. aureus and Streptococci. Brucella is a rare causative agent of epididiymoorchitis reported in 1.6-10.9% of adults. It is very rarely seen in adolescents or children(1,5).

In brucellosis endemic areas, clinicians must consider this possibility in a febrile patient presenting with pancytopenia and scrotal swelling.

References

1. Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajiahmadi M. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect 2004; 132: 1109-1114.

2. Akdeniz H, Irmak H, Seckinli T, Buzgan T, Demiroz AP. Hematological manifestations in brucellosis cases in Turkey. Acta Med Okayama 1998; 52: 63-65.

3. Karakukcu M, Patiroglu T, Ozdemir MA, Gunes T, Gumus H, Karakukcu C. Pancytopenia, a rare hematologic manifestation of brucellosis in children.J Pediatr Hematol Oncol 2004; 26: 803-806.

4. Varga J, Zivkovic D, Grebeldinger S, Somer D. Acute scrotal pain in children: Ten years’ experience. Urol Int 2007; 78: 73-77.

5. Memish Z, Mah MW, Mahmoud SA, Shaalan MA, Khan MY. Brucella bacteremia: clinical and laboratory observations in 160 patients. J Infect 2000; 40: 59-63.