Amiodarone-Induced Epididymitis: A Pathologically Confirmed Case Report and Review of the Literature

Abstract

We report a case of amiodarone-induced epididymitis and review the pertinent literature. This disease is currently a diagnosis of exclusion and is believed to be self-limiting. We found new evidence for the pathological diagnosis and identified amiodarone-like crystals in the epididymis as a pathological mechanism of this disease. This case also suggests that amiodarone-induced epididymitis is not self-limiting. Continued use of amiodarone according to the current guidelines led to a bilateral epididymectomy. We recommend withdrawal or reduction of amiodarone dosage immediately once the signs and symptoms of epididymitis present in this population of patients. When epididymitis does not seem to be caused by an infection or any other identifiable etiology, this should not be overlooked by the cardiologist, urologist or general practitioner. These findings and recommendations should help reduce the suffering of patients and improve their clinical outcomes.

Amiodarone-Induced Epididymitis: A Case Report and Review of the Literature

“…In one case report, the patient suffered from amiodarone-induced epididymitis for 11 weeks, eventually requiring a bilateral epididymectomy. Following the epididymectomy, amiodarone-like crystals were identified in the epididymis, similar to those seen in skin changes associated with amiodarone [ 6 ]. Patients suspected to have amiodarone-induced epididymitis should be treated with dose reduction or cessation of amiodarone in favor of another antiarrhythmic medication.…”

“…Amiodarone-induced epididymitis presents with chronic epididymyalgia in the absence of fever or leukocytosis and has a variable presentation time that ranges from 4 to 71 months after starting amiodarone [ 1 , 7 , 8 ]. The scrotal pain may be unilateral or bilateral, with more severe pain on one side [ 6 , 8 , 9 ]. The natural history of amiodarone-induced epididymitis is highly variable but usually requires discontinuation [ 7 , 10 ] or amiodarone dose reduction [ 9 , 11 ].…”

“…The pathogenesis of amiodarone-induced epididymitis is poorly understood, and the diagnosis is made clinically after other possible causes have been excluded. Amiodarone and its metabolite (desethylamiodarone) can concentrate up to 3,000 times higher in testicular tissue than the plasma concentration; the reason for this high testicular concentration of amiodarone is unclear [ 6 , 7 ].…”

Overview of ultrasound applications for assessing scrotal disorders

“…In sexually active patients, the most common cause is a bacterial infection with Neisseria gonorrhoeae or Chlamydia trachomatis . Vascular afflictions such as Henoch‐Schönlein purpura or polyarteritis nodosa or medications such as amiodarone can also lead to epididymitis . The distinction between epididymis and the testicle by clinical palpation is often difficult.…”