TESTICULAR INFARCTION ASSOCIATED WITH SICKLE CELL DISEASE

Abstract

Listen

Translate article

To our knowledge testicular infarction as the initial presentation of sickle cell disease has not been previously reported. We report a case of segmental testicular infarction attributable to sickle cell disease and discuss etiologies of infarction. CASE REPORT A 57-year-old black man presented with a 2-week history of testicular swelling unresponsive to oral antibiotics. He had no prior symptoms related to sickle cell disease. Physical examination revealed a right solid testis mass suspicious for malignancy. Testicular ultrasound demonstrated a right hyperechoic intratesticular mass with an anechoic rim (see figure). Doppler ultrasound showed normal flow in the surrounding parenchyma. Tumor markers were negative. Radical orchiectomy revealed hemorrhagic infarction with sickled red blood cells. Hemoglobin electrophoresis demonstrated sickle cell disease. DISCUSSION Testicular infarction as a global process more commonly occurs secondary to torsion of the spermatic cord. Segmental hemorrhagic infarction of the testis occurs less frequently and approximately 15 cases have been reported in the literature.' Previously, testicular infarction has been described in a patient with sickle cell trait but not in a patient with sickle cell disease.' Antecedent symptoms include testicular pain and scrotal swelling usually without dysuria or discharge. Often scrotal color Doppler ultrasound indicates a well circumscribed hypoechoic area, indistinguishable from a malignant process, and significantly decreased intratesticular flow. Orchiectomy is often performed due to the inability to characterize the lesion as a benign process. Etiologies of the majority of hemorrhagic infarctions are unknown, although a number of predisposing factors are associated, including polycythemia, hypersensitivity angiitis, blunt trauma and rheumatological disorders.' The rare occurrence of segmental infarction may be a result of multiple testicular arterial supply. Testicular blood flow is dependent on the internal spermatic, cremasteric and deferential arteries. Obstruction of venous outflow may create venous thrombosis, testicular engorgement and subsequent hemorrhagic infarction. Rarely, a thrombus of the internal spermatic artery results in hemorrhagic infarction.' The pathophysiology of sickle cell disease is based on local factors that enhance the formation of deoxyhemoglobin.4 Acidosis, dehydration resulting in hypertonic plasma and increased erythrocyte 2, 3-biphosphoglycerate are all factors