An Unrecognized Trauma as a Cause of Recurrent Fever
- 1. Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Turkey
- 2. Department of Pediatric Surgery, Erzurum Regional Training and Research Hospital, Turkey
- 3. Department of Pathology, Erzurum Regional Training and Research Hospital, Turkey
- 4. Department of Pediatrics, Erzurum Regional Training and Research Hospital, Turkey
Citation
Kara SS, Cevizci MN, Bilici AE, Cayir A (2017) An Unrecognized Trauma as a Cause of Recurrent Fever. Ann Clin Cytol Pathol 3(2): 1053.
CLINICAL IMAGE
A 16-year-old boy presented with a 1-week history of fever and scrotal pain, which had recently occurred twice previously. He denied any history of trauma, urethral discharge, or sexual intercourse. He had chronic renal failure secondary to vesicoureteral reflux, and was continuing with hemodialysis and using immunosuppressant drugs. Diffuse edema and tenderness in the scrotum were observed at physical examination (Figure 1A). Elevated acute phase reactants were determined. Scrotal ultrasound revealed bilateral dense, septated fluid collections, located near normal appearing testes. Empirical piperacillintazobactam plus vancomycin were started. He was then operated. Bilateral proximal inguinal hernia sacs were ligated, and two masses were resected (Figure1B,1C). Histopathological examination revealed two unilocular cystic structures, with abscess foci, calcification areas, and a fibrovascular wall, but no epithelial wall (Figure 1D). Blood culture was negative. Methicillin-sensitive Staphylococcus aureus grew in cyst material culture. His symptoms resolved after surgery.
Benign intrascrotal lesions, which mostly occur in para testicular tissue and are cystic in nature, are common in male patients [1]. Definitive diagnosis usually requires surgical procedures to discard malignancy. In this case, histological findings suggested infection of a benign chronic lesion and absence of a ‘real’ cyst, indicating an unrecognized traumatic injury experienced years previously. Although immune compromised patients usually experience recurrent fever or fever of unknown origin, infection of a pseudo cyst caused by an unrecognized trauma is not a frequent reason. Unsurprisingly, cyst material grew S. aureus, the predominant micro-organism in genitourinary skin and soft tissue infections requiring incision and drainage [2]. As the patient was a child and the lesion was benign, a testis sparing procedure was performed in addition to antibiotic therapy. Resection of the foci helped to prevent subsequent infections.
Informed consent was taken from both the patient and his legal guardian.
ACKNOWLEDGEMENTS
This study was presented as a poster presentation at 13th National Pediatric Infectious Diseases Symposium, September 29-October 02, 2016, Eskisehir/Turkey.