Amiodarone induced epididymo-orchitis

Abstract

Amiodarone has a well-established and extensive side effect profile: pulmonary fibrosis, thyroid toxicity, corneal deposits, and skin discoloration. However, in some rare instances epididymitis/orchitis is a side effect of amiodarone. Symptoms range from testicular pain to swelling and erythema. 1,2 The mechanism of how this toxicity occurs is unknown. In this case report, we will discuss the case of an elderly patient who developed epididymitis and orchitis after several years of tolerating amiodarone without any adverse events. Our patient underwent a full workup with testicular ultrasound, evaluation by the urology and cardiology services. His amiodarone was discontinued with complete resolution of symptoms. Data sources A community hospital in Stratford, NJ. Study selection 88 year old male patient with multiple comorbidities. Data extraction Obtaining medical records on Soarian Cerner system. Data synthesis Article analysis obtained from PubMed.

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

“…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 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 ]. In one case report, the patient suffered from amiodarone-induced epididymitis for 11 weeks, eventually requiring a bilateral epididymectomy.…”

“…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 ].…”

Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation

“…Autoimmune thyroiditis often combines with other autoimmune diseases, sometimes, with autoimmune orchitis. For example, amiodarone (anti-arrhythmic medicine with a huge content of iodine) induces both thyroid and testicular autoimmunity [ 147 ]. In Hashimoto’s thyroiditis, an increased level of autoantibodies to steroid-producing cells may be observed, with decreased serum testosterone, which causes altered spermatogenesis, resulting in a low concentration of spermatozoa, a decreased number of progressive motile spermatozoa, and morphologically abnormal spermatozoa in semen [ 148 ].…”

Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine and Endocrine Deregulation

“…Autoimmune thyroiditis often combines with other autoimmune diseases, sometimes, with autoimmune orchitis. For example, amiodarone (anti-arrhythmic medicine with huge content of iodine) induces both thyroid and testicular autoimmunity [148]. In Hashimoto's thyroiditis increased level of autoantibodies to steroid-producing cells may be observed, with decreased serum testosterone, which causes altered spermatogenesis, resulting in low concentration of spermatozoa, a decreased number of progressive motile spermatozoa and morphologically abnormal spermatozoa in semen [149].…”