Conservative treatment for Brucella testicular abscesses: A case report and literature review

Brucellar testicular abscess: The 17th case report and review of literature

Brucellosis is an endemic zoonotic disease caused by intracellular gram-negative coccobacilli called Brucella. This infectious disease may implicate many farm animals and is transmissible to exposed humans. Brucellosis is potentially life-threatening and may lead to granulomatous multi-organ involvement with tendency to chronicity and recurrence. The treatment of brucellosis requires combined and protracted antimicrobial therapies to eliminate the disease and to avoid its relapse. Genitourinary brucellosis is common among infected humans in endemic areas and is considered the second-most affected focal site, which commonly manifests as epididymo-orchitis. Testicular abscess, however, is an extremely rare complication of brucellosis. To the best of our knowledge, in the literature, there are to date only 16 previously published case reports, including 22 patients of brucellar testicular abscesses, emphasizing the extreme rarity of this condition. Most of these cases harbored small abscesses, which were treated conservatively using antibiotics therapy only, or with added drainage of the abscesses. Larger abscesses were reported to necessitate orchiectomy. In some cases, the abscesses were mimicking tumors, and surgeries for orchiectomy were done accordingly. A summary of the previously reported cases in the literature is presented. Here, we present the 17th case report of a 34-year-old man with a right-side huge multilocular brucellar testicular abscess apparently replacing the entire testicle, who was successfully treated with organ-sparing management by incision-drainage of the large abscess with antibiotics, to eventually preserve his testis. In conclusion, brucellosis should be considered among the differential diagnoses of any testicular swelling, especially in endemic areas. Drainage of brucellar testicular abscess with appropriate medical treatment is feasible and may preserve the testicle, even with large abscess apparently replacing the entire testicle.

Brucella epidydimo-orchitis successfully treated with dual oral drug regimen: A case report with differential diagnoses of malignancy and tuberculosis

Brucellosis is a zoonotic disease caused by Brucella spp. When complicated, Brucella may affect any organ system, including the genitourinary system in the form of epidydimo-orchitis. Brucella orchitis is the second most common form of complicated brucellosis. The present case is for an adolescent who is otherwise healthy but presented with right testicular pain. Ultrasound imaging showed heterogeneous enlarged right testis with large heterogeneous mass and central necrosis. α-fetoprotein was normal and β-human choriogonadotropin was negative. Malignancy and tuberculosis were excluded based on histopathology and microbiology of the tissue biopsy, respectively. The history of raw dairy consumption and positive serology for B. melitensis and B. abortus established the diagnosis of Brucella epidydimo-orchitis. Treatment was successful with doxycycline and rifampin for four weeks. In pediatrics, it is important to rule out malignancy and make every attempt to avoid orchidectomy by making necessary investigations and involving infectious diseases consultation.