Hard bilateral syphilitic testes with vasculitis: a case report and literature review

Abstract

Background We report the case of a patient with syphilitic testicular gumma and vasculitis with adrenal failure due to chronic steroid use. Case presentation A 63-year-old male presented with hard right eye swelling and very firm bilateral testes on palpation, which he had for 2 years. Testicular tumor markers were negative; syphilis test was positive. Radiological examination suggested aortitis and bilateral testicular malignancy. The patient received ampicillin for the infection and prednisolone for vasculitis. Left orchidectomy was performed to confirm the presence of testicular tumor; histological examinations revealed granulomatous orchitis. The prednisolone doses were adjusted because of relapses and adverse effects of steroid use. Unfortunately, the patient died in the intensive care unit because of uncontrolled blood pressure and pneumonia. Conclusions This is a rare case of syphilis with testicular involvement and vasculitis. This report shows the importance of broadening the differential diagnoses of testicular firmness.

Viruses, bacteria and parasites: infection of the male genital tract and fertility

“…In addition to the observed testicular and/or scrotal swelling [ 163 – 165 , 167 , 168 ], the diagnosis often relies on ultrasound examination and sometimes reveals a testicular mass suspicious for malignancy, which generally leads to orchidectomy [ 165 – 167 ], even if some work succeeded in saving the patient’s testicle using antibiotics [ 163 ]. Testicular infection can give rise to typical gummatous orchitis [ 165 , 167 – 170 ], that is a central necrotic area surrounded by inflammatory cells (mainly lymphocytes and plasma cells) or to atypical lesions devoid of necrosis [ 164 , 166 ]. Other testicular damage were described, like atrophy or destruction of the seminiferous tubules [ 164 , 168 , 170 ], destruction of parenchyma [ 168 ] or obliterative vasculitis in some blood vessels [ 164 ], making syphilis a very likely cause of male infertiltiy, even if no infertility cases directly resulting from T. pallidum infection have been reported.…”

“…Testicular infection can give rise to typical gummatous orchitis [165,[167][168][169][170], that is a central necrotic area surrounded by inflammatory cells (mainly lymphocytes and plasma cells) or to atypical lesions devoid of necrosis [164,166]. Other testicular damage were described, like atrophy or destruction of the seminiferous tubules [164,168,170], destruction of parenchyma [168] or obliterative vasculitis in some blood vessels [164], making syphilis a very likely cause of male infertiltiy, even if no infertility cases directly resulting from T. pallidum infection have been reported. Finally, like gonorrhoea, syphilis has been linked to an increased risk of developing prostate cancer [146,171].…”