Orchiepididymitis in the context of multisystem inflammatory syndrome in a child with Covid-19 from Syria: a very rare presentation for SARS-Cov-19 in children

Abstract

The coronavirus disease 2019 (COVID-19) is still striking the global population affecting all age groups. So far, many clinical features associated with COVID-19 illness remain under-identified, especially atypical manifestations. It is essential to characterize associated rare symptoms to better recognize complications. As severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes Multisystem Inflammatory Syndrome in children (MIS-C) in severe infection manifesting as a generalized inflammatory reaction and immune response in many body systems, potential involvement of the male urogenital tract by SARS-CoV-2 should be considered. Herein, we report a case of a pediatric patient with orchiepididymitis associated with COVID-19 infection, emphasizing the importance of considering other manifestations such as genital involvement of MIS-C in children with COVID-19 and highlighting the need to monitor the genitourinary function after infection. Therefore, andrological consultation is necessary to evaluate fertility as a long-term follow-up, especially as the effects of SARS-CoV-2 on male reproductive function are still to be thoroughly researched.

Scrotal pain as a novel symptom of multisystem inflammatory syndrome in children (MIS-C): Report from Riyadh, Saudi Arabia

“…Both had unilateral inguinal swelling and erythema. 4,5 Another reported scrotal ulcers as a presentation of MIS-C. 6 Yet, these presentation remains rare for MIS-C, which indicates the need to remain vigilant when dealing with its differing presentations. To the best of our knowledge, this is the first reported case of scrotal pain as a symptom of MIS-C in Riyadh, Saudi Arabia.…”

“…Due to the plethora of cells with ACE2 expression in the genitourinary tract, testicular cells might be a target for the disease. 5 Nonetheless, no clear mechanism is established yet.…”

A 7-year-old Boy with Orchitis after COVID-19 Infection

“…The first case of orchiepididymitis associated with COVID-19 was reported in a 14-year-old boy in Italy (7). After that, M.Haydar et al reported a case of epididymitis in the setting of MIS-C (multisystem inflammatory syndrome in children) in a 7-year-old boy from Syria (8). In a systematic review conducted on 575 patients, including 538 males, scrotal discomfort, swelling, pain, and erythema were described in 39 patients, among whom acute orchitis was found in 10 patients and acute orchiepididymitis in 10(3).…”

Necrotizing Epididymo-Orchitis: A Rare Manifestation of COVID-19

“…Some of the urogenital Case Reports in Urology complications caused by COVID-19 have been secondary to hypercoagulable states [5]. There are some case reports regarding patients with epididymo-orchitis symptoms such as abdominal, testicular, and back pain; bilateral testicular warmth, testicular discomfort, swelling, pain, and erythema; and concurrent COVID-19, without any respiratory symptom [5,6,[10][11][12][13]. These studies reported NSAID or antibiotic therapy would be successful in all patients with testicular pain, and no patient required more invasive procedures [4,6,14,15].…”