Scrotal Cellulitis Research Articles

Subglottic Stenosis in a 3-Year-Old Child Following Prolonged Intubation - A Case Report

Subglottic stenosis is a serious complication of prolonged intubation in pediatric patients and Over 90% of acquired cases are iatrogenically caused and result from endotracheal intubation. Subglottic stenosis is an unanticipated problem that needs to be diagnosed and treated immediately. The majority of pediatric subglottic stenosis occurrences are mild to moderate. This case highlights the challenges and outcomes associated with this condition. Here, we present a 3-year-old child presented with high fever and scrotal pain with swelling, diagnosed as scrotal cellulitis. Laboratory results showed anemia, leukocytosis, and metabolic acidosis, and the child's condition deteriorated due to respiratory distress, requiring intubation and PICU admission. Following a scrotal abscess drainage, the child was discharged but returned with severe respiratory distress, cyanosis, and subglottic stenosis, confirmed by laryngobronchoscopy and imaging. After failed extubation attempts and further complications, a tracheostomy and endoscopic subglottic dilation were performed. The child was successfully decannulated after eight days, with near-complete recovery except for a slight change in voice tone. The case highlights the challenges in managing complex respiratory complications in pediatric patients. This case underscores the importance of monitoring for subglottic stenosis in children who have undergone prolonged intubation and demonstrates the efficacy of endoscopic dilatation in managing this complication.

Safety assessment of dapagliflozin: Real-world adverse event analysis based on the FAERS database from 2012 to 2023

BackgroundDapagliflozin possesses the capacity to cure a wide range of diseases, however, there are many adverse events (AEs) that have not yet been acknowledged or recorded. AimSafety assessment of dapagliflozin based on the Food and Drug Administration Adverse Event Reporting System (FAERS) database, to explore differences between the reported AEs to provide a overview of the safety profile of dapagliflozin. MethodsWe extracted data from the United States FAERS database, including from the fourth quarter of 2012 to the third quarter of 2023. Reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and empirical Bayesian geometric average (EBGM) were used to evaluate the relationship between dapagliflozin and its associated AEs. ResultsA total of 13,593,946 case reports were gathered from the Food and Drug Administration Adverse Event Reporting System database for this investigation. Among these, there were 44,506 episodes of adverse events that were associated with dapagliflozin. Included in the analysis were 341 preferred words and 2 system organ classes that showed statistical significance according to all four methods simultaneously. The system organ classes encompassed illnesses related to metabolism and nutrition, as well as problems affecting the renal and urinary systems. PT levels were screened for adverse drug reaction signals including scrotal gangrene, scrotal cellulitis, perineal cellulitis, diabetic ketoacidosis, and pancreatitis. ConclusionThe majority of our findings aligned with the specification, however, certain novel indicators of AEs such as acute pancreatitis were not accounted for. The analysis of the AE signals may provide support for clinical monitoring and risk identification of dapagliflozin. Due to the inherent limitations of FAERS data, well-designed studies are required to demonstrate the safety of dapagliflozin.

Mpox infection in an AIDS patient with syphilis manifesting with scrotal and penile cellulitis

Mpox infection in an AIDS patient with syphilis manifesting with scrotal and penile cellulitis

A CROSS-SECTIONAL STUDY TO ASSESS CLINICO-EPIDEMIOLOGICAL FACTORS, DIAGNOSIS AND MANAGEMENT IN PATIENTS WITH ACUTE SCROTAL CONDITIONS

Background: Many acute scrotal conditions can present in similar way, Testicular torsion is a true surgical emergency because, the likelihood of testicular salvage decreases, as the duration of torsion increases. Other conditions that present in similar way to testicular torsion include, torsion of appendix testis, epididymo - orchitis, blunt trauma to testis, fournier's gangrene, haematocele, pyocele, etc. Aim: Assessment of clinico-epidemiological factors, diagnosis and management in patients with acute scrotal conditions. Methods: This observational, cross-sectional study was conducted on 75 patients which includes all cases of acute scrotal conditions within age group of 5 years to 70 years presenting to surgery OPD or casualty and getting admitted in a tertiary care centre in eastern part of Maharashtra during the period. Results: In our study acute epididymo-orchitis (46.7%) was the commonest cause of acute scrotal pathology followed by Fourneir's gangrene (24%).Incidence of scrotal cellulitis, pyocele, torsion testis, haematocele, were 9.3%,8%,6.7%, 2.7% respectively. One case each of testicular abscess(1.3%) and testicular tumour (1.3%) were also found. Out of 75 cases, 36 cases (48%) were managed conservatively. In Fournier's gangrene, only debridement was done in 8 cases, multiple debridement with secondary suturing was done in 5 cases, multiple debridement followed by skin grafting was done in 5 case. Scrotal exploration and drainage of testicular abscess was done in 1 case. Scrotal exploration with evacuation of hematoma was done in 2 cases of haematocele. Orchidectomy was done in total of 4 cases in which 3 cases have clinical diagnosis of testicular torsion and one case of testicular tumour. Also orchidectomy with contralateral orchidopexy was done in 2 cases of testicular torsion. Conclusion: The most common cause of acute scrotum was epididymo - orchitis which can be managed conservatively. Early exploration can salvage the testis in cases torsion of testis.

Acute Scrotum in Children: A Retrospective Study of Cases With Review of Literature.

Testicular pain or swelling, often referred to as acute scrotum, can have a number of causes and presentations. Testicular torsion is an emergency condition requiring early diagnosis and surgery to salvage the involved testis in order to preserve testicular fertility. The study is aimed to know the incidence, aetiology, and management of acute scrotal conditions with a particular focus on testicular torsion. Epididymorchitis, trauma, and scrotal cellulitis are other causes of acute scrotum which are managed conservatively after proper investigations. The authors retrospectively reviewed 10-year epidemiological data of all children age under 14 years admitted to the tertiary care hospital with the diagnosis of acute scrotum. Data were collected about the clinical history, physical examination, biochemical investigations, Doppler ultrasound, and management done. 133 children aged between 0 days and 14 years (mean age, 7.5 years) were found to have acute scrotum out of which 67 (50.37%) patients had epididymitis, 54 (40.60%) patients presented with Torsion testis, three (2.25%) had torsion of testicular appendages, eight (6.01%) had scrotal cellulitis and one (0.75%) presented with a strangulated hernia. Due to late presentation, testis could be salvaged in only eight of the 54 patients with torsion testis. The testicular loss was seen more in bigger children and those with signs of infection in blood reports and colour Doppler showing no blood flow in the testis. The study results indicate that non-recognition of the severity of paediatric acute scrotum results in late presentation leading to testicular loss. Timely diagnosis will require sensitization of the parents, primary care providers, and paediatricians for this grave condition which leads to permanent testicular loss.

Neonatal Scrub Typhus—A Case Report

Scrub typhus is the most common rickettsial infection in India. A neonate with suspected late-onset sepsis/late hemorrhagic disease of newborn and scrotal cellulitis was finally diagnosed as scrub typhus. The samples of blood and urine were sent and azithromycin was started empirically awaiting the reports. The baby improved with resolution of fever and increased oral acceptance and thrombocytopenia resolved. In any newborn presenting with fever, eschar, and positive family history, besides other common diagnoses like sepsis, scrub typhus should also be suspected as a differential diagnosis, especially in endemic countries. Prompt diagnosis and early initiation of treatment will reduce mortality and morbidity of newborns with scrub typhus.

SARS-COV-2 Positive Patient with Fournier’s Gangrene and Multiorgan Complications

Fournier gangrene is a rare type of necrotizing fasciitis of the genital or anorectal region that rapidly progresses towards diffuse tissue necrosis and mortality if untreated. As seen in this case, the disease is difficult to diagnose in its early stages due to a lack of pathognomonic signs that differentiate it from a localized scrotal abscess, cellulitis, pyoderma gangrenosum, and orchitis. These initial findings of Fournier’s gangrene make rapid diagnosis difficult, thus we recommend a low threshold for further workup based on exam findings and clinical suspicion. Emergent imaging modalities and cultures can aid in the diagnosis but should not delay surgical debridement and broad-spectrum antibiotics -the gold standard of treatment for Fournier’s gangrene. This case also presents possible correlations between SARS-CoV-2 and Fournier’s gangrene, but further research must be conducted to delineate clinical course management in patients with SARS-CoV-2 and Fournier’s gangrene.

Frequency of Urinary Tract Infections, Gonorrhea, and Chlamydia in Emergency Department Patients With Acute Scrotal Pain.

Background: Acute scrotal pain has many causes. According to the American Urological Association recommendations: history, physical examination, and ultrasound are key in diagnosing acute scrotal pain.Objective: The primary objective of this study was to evaluate the frequency of urinary tract infections (UTI) on routine Urinalysis (UA) in patients presenting with acute scrotal pain to the emergency department (ED).Methods: We conducted a multicentered retrospective chart review of patients who presented to the ED with acute scrotal pain. Patient visits from February 1, 2018 to November 1, 2019 from 13 EDs were analyzed. Demographic data, UA interpretation, urine culture, gonorrhea and chlamydia (GC) testing, clinical findings, treatment outcomes, and ultrasounds were recorded. Patients who did not have a UA and scrotal ultrasound performed or who had a diagnosis of scrotal cellulitis or soft tissue infection were excluded.Results: There were 2,392 patients included in the study. A UTI was present in 173 (7.2%) patients. Of the patients who were found to have a UTI, 100/173 (57.8%) had a concomitant ultrasound diagnosis of epididymitis/orchitis. Also, 731 patients underwent GC testing in addition to standard UA collection, and ultrasound, seven were positive for gonorrhea (0.95%), and 30 were positive for chlamydia (4.10%).Conclusions: Routine UA collection of patients presenting to the ED with acute scrotal pain should be considered, especially in patients with a concomitant ultrasound diagnosis of epididymo-orchitis. GC testing has limited yield without symptoms suggestive of sexually transmitted infections and a normal ultrasound.

Urological Emergency in a University Hospital Setting: Epidemiological, Diagnostic and Therapeutic Aspects

Aim: To report the epidemiological and diagnostic aspects and evaluate the management of urological emergency in a university hospital. Patients and method: We conducted a single-center retrospective descriptive study over the period January 2015 to December 2017. We collected medical records of patients with urological emergency referred by the urology care team in our center. Results: Three hundred patients were identified over a period of 36 months. The mean age of the patients was 47.8±22.9 years (2 years - 92 years). The sex-ratio was 10.5. The most common emergency was haematuria (25.6%) and urinary retention (21.6%). Urogenital infections were noted in 19% of patients mostly scrotal cellulitis (10%) and acute pyelonephritis (3.6%). The number of emergency hospitalization was 230 (76.7%). We performed 143 emergency surgical procedures (47.6%). The overall mortality rate was 1%. Conclusion: Urological emergency were dominated in our context by hematuria and urinary retention occurring most often in young adults. However, infectious and lithiasic diseases remain common conditions.

Urological Evidence of Tick Bites in Children.

Ticks pose a serious threat to individuals of all ages owing to numerous physical illnesses including chills, aches, and a rash. Tick-borne illnesses range from a mild fever that may be treated at home to a severe disease necessitating hospitalization. Children are at an increased risk of tick bites owing to to their exposure to tick-infested areas during the summer. We report 2 cases of boys aged 3 and 8 years who sustained tick bites to the hemiscrotum and penis. Overnight hospitalization and a course of antibiotics were mandatory. In the first case, the child experienced significant scrotal cellulitis with erythema and edema extending to the suprapubic area with induration of the right anterior scrotum at the site of the tick bite. A scrotal ultrasound demonstrated swelling of the scrotal wall. In the second case, considerable swelling and induration of the distal penis and glans, pruritis of the left groin and penis, and an erythematous rash over the entire anterior pelvis were observed. A high index of suspicion is warranted because a tick bite may present as penile edema. Pediatric emergency physicians should be aware of the risks associated with tick bites and accurately diagnose and initiate treatment to prevent morbidity and mortality.

3083 Campylobacter coli bacteremia: How Common Is It?

INTRODUCTION: Campylobacter species are known to cause enteritis, usually self-limited, but with the risk of developing Guillain Barre Syndrome. However, over the past 40-50 years, there have been reports of varying presentations, such as cellulitis, spondylodiscitis, and bacteremia. Of the Campylobacter species, C. jejuni is the most common culprit for causing bacteremia, however, C. coli bacteremia is becoming more prevalent. Here we discuss an unusual case of C. coli bacteremia in a patient with decompensated liver cirrhosis. CASE DESCRIPTION/METHODS: 59 y/o with history of cirrhosis secondary to alcohol abuse complicated by esophageal varices, who presented with black, watery stools in the previous one week with concurrent scrotal swelling. Vital signs were stable with temperature of 97.6 degrees F, heart rate 84 bpm, respiratory rate 16, blood pressure 117/72, and oxygen saturation 99% on room air. Physical exam was remarkable for voluntary guarding, and right upper quadrant tenderness. Lab tests revealed a white blood count of 2300/cm2, hemoglobin 9.9 g/dL, alkaline phosphatase 132 IU/L, aspartate aminotransaminase 65 U/L, alanine aminotransaminase 26 U/L, lactic acid 5.0 mmol/L, magnesium 1.2 mg/dL, and phosphorus 2.2 mg/dL. Computed tomography abdomen/pelvis with contrast showed findings of colitis. Ultrasound of the scrotum showed possible scrotal cellulitis. Stool culture returned positive for Campylobacter antigen, for which doxycycline was initiated. Blood cultures resulted with gram negative rods, which were later confirmed to be C. coli. Blood cultures continued to grow the bacteria and antibiotics were switched to imipenem until the day of discharge. Unfortunately, the patient left the hospital against medical advice and was sent home with ciprofloxacin to complete a total antibiotic course of 2 weeks after the last negative blood culture. Patient was seen at his primary care physician's office 4 days after leaving the hospital and reported complete resolution of his symptoms. DISCUSSION: Campylobacter bacteremia is rare. We must be aware of the possibility of a Campylobacter bacteremia and consider this organism when choosing empiric antibiotics. Additionally, once confirmed of a Campylobacter bacteremia, we must be mindful of resistance and choose treatment wisely. As Campylobacter infections have a wide array of presentations, it is imperative that cases are shared amongst the medical community so that prompt recognition, diagnosis, and treatment can be offered.

Testicular wedge biopsy for fertility preservation in children at significant risk for azoospermia after gonadotoxic therapy

Background/purposeTesticular tissue cryopreservation (TTC) provides an experimental option for fertility preservation for male children at significant risk for azoospermia owing to high-risk gonadotoxic treatments. MethodsA single institution, retrospective review of TTC cases from 2015 to 2017. Children at significant risk for azoospermia were eligible for study inclusion. A unilateral wedge biopsy of the testis was performed for TTC. ResultsTTC was performed in 23 patients. Average age was 10 years old (5 months to 18 years). Diagnoses included solid tumor (74%, n = 17), hematologic malignancy (17%, n = 4), and benign hematologic disease (13%, n = 3). Six patients had TTC at the time of disease relapse. Nine patients were referred for TTC prior to stem cell transplantation. The majority (70%, n = 16) of patients had an additional procedure at the time of TTC. One patient developed postoperative scrotal cellulitis that was treated with antibiotics. The majority of patients (96%, n = 22) had normal testicular tissue with the presence of germ cells on histopathological analysis. Median time to start of medical therapy was seven days with no unanticipated treatment delays. ConclusionsTesticular wedge biopsy for TTC can be performed safely, coordinated with other necessary procedures, and does not delay the start of treatment. TTC remains an experimental option for fertility preservation for children, as no spermatogenic recovery or pregnancies from cryopreserved testicular tissues have been reported to date. Level of evidenceIV.

A Surprising Infection After Scrotal Cellulitis

From the *Stony Brook University School of Medicine, Stony Brook; and †Veterans Affairs Medical Center, Northport, NY. Correspondence to: George Psevdos, MD, 79 Middleville Rd, Northport, NY 11768. E-mail: [email protected]. The authors have no funding or conflicts of interest to disclose.

Fournier's Gangrene: A Model for Early Prediction

Early diagnosis remains the cornerstone of management of Fournier's gangrene. As a result of variable progression of disease, identifying early predictors of necrosis becomes a diagnostic challenge. We present a scoring system based on objective admission criteria, which can help distinguish Fournier's gangrene from nonnecrotizing scrotal infections. Ninety-six patients were identified, 38 diagnosed with Fournier's gangrene and 58 diagnosed with scrotal cellulitis or abscess. Statistical analyses comparing admission vital signs, laboratory values, and imaging studies were performed and Classification and Regression Tree analysis was used to construct a scoring system. Admission heart rate greater than 110 beats/minute, serum sodium less than 135 mmol/L, blood urea nitrogen greater than 15 mg/dL, and white blood cell count greater than 15 × 10(3)/μL were significant predictors of Fournier's gangrene. Using a threshold score of two or greater, our model differentiates patients with Fournier's gangrene from those with nonnecrotizing infections with a sensitivity of 84.2 per cent. Only 34.2 per cent of patients with Fournier's gangrene had hard signs of necrotizing infection on admission, which were not observed in patients with nonnecrotizing infections. Objective admission criteria assist in distinguishing Fournier's gangrene from scrotal cellulitis or abscess. In situations in which results of the physical examination are ambiguous, this scoring system can heighten the index of suspicion for Fournier's gangrene and prompt rapid surgical intervention.

Regarding extremely large inguinal hernias with a contribution of two cases

We report two men of ages 62 and 80 years, respectively, with giant inguinoscrotal hernias. They were operated with a single-stage repair by two approaches, extended preperitoneal of Nyhus and an inguinal method. After hernia content reduction, a policaproamide antimicrobial mesh Ampoxen (MEDICA SA, Sandanski, Bulgaria) with dimensions 20 x 30 cm was inserted by using Stoppa's technique. An additional inguinal reinforcement with other mesh patch was done on the external aponeurosis hernial defect. Synchronous orchiectomy and transscrotal drainage of both patients was performed. The first patient suffering from umbilical hernia was also operated at the same stage. He was prepared by preoperative pneumoperitoneum. The second patient, due to scrotal skin cellulitis with ulceration, was operated without pneumoperitoneum preparation. The latter created easier mobilization and reduction of the hernial content. The sizable mesh dimensions allowed, to some degree, an acceptable level of intra-abdominal pressure after the repair. These hernias demand interdisciplinary teamwork and their treatment has to be adapted to the individual condition of the patient using all therapeutic options.

Acute Testicular Disorders

1. John M. Gatti, MD* 2. J. Patrick Murphy, MD† 1. *Associate Professor, University of Missouri at Kansas City School of Medicine; Director, Minimally Invasive Urology, Children's Mercy Hospital, Kansas City, Kan 2. †Professor, University of Missouri at Kansas City School of Medicine; Chief, Section of Urology, Children's Mercy Hospital, Kansas City, Kan After completing this article, readers should be able to: 1. Describe the appropriate evaluation and management of the acute scrotum. 2. Discern testicular torsion from other, less urgent conditions that may mimic it. 3. Discuss the importance of prompt diagnosis and treatment of testicular torsion for gonadal salvage. Acute scrotal pain with or without swelling and erythema in the child or adolescent male should be treated as an emergent condition. The differential diagnosis includes: torsion of the spermatic cord, appendix testis or epididymis, epididymitis/orchitis, hernia, hydrocele, trauma, sexual abuse, tumor, idiopathic scrotal edema (dermatitis/insect bite), cellulitis, and vasculitis (Henoch–Schonlein purpura). Most of the conditions are nonemergent, but the prompt diagnosis and treatment of torsion of the spermatic cord is imperative to avoid permanent ischemic damage to the testicle. The most common causes of acute scrotal pain are testicular (spermatic cord) torsion and torsion of the rudimentary vestigial appendages of the testicle or epididymis. The child's age suggests the cause of the acutely painful scrotum because torsion of the appendix testes/epididymis is more common in prepubertal boys and spermatic cord torsion occurs more frequently in adolescents and newborns. Torsion of the testicle results from twisting of the spermatic cord, which compromises testicular blood supply. The number of twists determines the amount of vascular impairment, although generally a 4- to 8-hour window exists before significant ischemic damage occurs that can affect long-term testicular morphology and sperm formation. Testicular torsion is a true surgical emergency. Adolescent males tend to present beyond the “golden” 4- to 8-hour period, but urgent surgical treatment is indicated because viability of the testis is difficult to predict. Two types of testicular torsion may occur. Extravaginal torsion results from twisting of the cord proximal to the tunica vaginalis. This mechanism occurs perinatally during descent of the testicle before the scrotal investment of …

Emergency diagnosis of Fournier's gangrene with bedside ultrasound

Fournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. Ultrasound has been previously described to aid in the diagnosis of Fournier's gangrene. In patients with low to moderate suspicion of Fournier gangrene, it may provide a rapid and reliable diagnosis and differentiate the pathological process from mimicking entities such as scrotal edema or cellulitis. We present 6 cases of Fournier's gangrene diagnosed in the ED at the patient's bedside using ultrasound. None of the patients had a history of diabetes, and 5 had sources of infection determined.

HUMAN SCROTAL MYIASIS (BOT FLY): A CASE OF SELF-DIAGNOSIS

The bot fly (Dermatobia hominis) is endemic to tropical regions of Central and South America. Human infestation in nonendemic areas is difficult to diagnose due to lack of disease familiarity, and lesions produced by this insect are often misdiagnosed for cutaneous furunculosis. Although the disease is self-limited, it causes significant pain. Thus, prompt identification may avoid unnecessary treatment with antibiotics and allow for early removal of larvae. To our knowledge we report the second case of scrotal infestation in the literature. Remarkably the patient arrived at our clinic with a self-diagnosis of bot fly infestation, and the larvae were excised with excellent results. CASE REPORT A 48-year-old male presented to the urology clinic with complaints of intense sharp intermittent pain in the scrotum which began approximately 1 week after traveling to Costa Rica. He recalled suffering a mosquito bite to the scrotum at this time while changing his clothes. Approximately 4 weeks after returning home he noticed 2 small “lumps” in the scrotum which drained serosanguineous fluid and caused intense intermittent episodes of pain. The patient consulted emergency medicine and internal medicine physicians before arrival to our clinic and was prescribed cephalexin for presumed furuncular scrotal cellulitis. However, since his condition did not improve his wife and he searched the Internet for information on rare insect bites endemic to Costa Rica and determined that the symptoms were caused by human bot fly infestation. The patient made several unsuccessful attempts to rid himself of the parasites using described tribal remedies to suffocate them. Physical examination revealed 2 superficial furuncular lesions with central pores from which serosanguineous dis

Scrotal cellulitis simulating testicular infarction by Tc-99m pertechnetate imaging.

A 37-year-old man with an extensive psychiatric history attempted self-castration by tightening a coat hanger around his scrotum. This action resulted in scrotal cellulitis. Scrotal imaging with Tc-99m pertechnetate was requested to assess testicular viability. The study shows increased activity surrounding the region of the coat hanger and extending inferiorly; activity was greater on the right side. An ovoid area of relatively decreased activity on the left was interpreted initially as left testicular infarction. Subsequent surgical exploration showed that both testicles were perfused normally. The relatively decreased activity on the left presumably represents an area of less severe cellulitus.

Idiopathic colitis associated with scrotal cellulitis

by The Rehabilitation Center of the New York University Medical Center. ~ They point out that the rate of loss of vital capacity slows once it has fallen below one liter. We saw dramatic restoration of activity in our patients after an initial period of aggressive treatment. Although bound to wheelchairs, Patients 1 and 5 have been able to resume their daily activities. They were not ready to die, and they and their families are grateful that they were given the option not to do so. Our patient with centronuclear myopathy is able to walk between classes without a wheelchair. All three of these young adults use their respirators only at night. We urge that any physician caring for children with neuromuscular disease include pulmonary function testing as part of the periodic examination. The option of ventilatory support should be thoroughly understood by patient, parent, and physician. Patients may wish to consider elective fitting of a cuirass prior to the onset of respiratory failure. Frequently, nighttime use may be all that is necessary. A cuirass seems to fit the unique needs of the patient with neuromuscular diseaseS: mobility, preservation of voice, and independence.