精巣膿瘍の2例

Abstract

症例1(53歳男).発熱, 有痛性右陰嚢腫脹を主訴とした.コントロール不良の糖尿病と脳梗塞の既往があり, 尿道カテーテル留置中に主訴が出現した.症例2(78歳男).発熱, 有痛性左陰嚢腫脹を主訴とした.Pseudomonas sp.による急性前立腺炎罹患後に主訴が出現した.2例とも検尿では膿尿と細菌尿を, 血液検査では著しい炎症所見を認め, 尿培養にて症例1からはEsherichia coliが, 症例2からはP.sp.が検出された.抗菌化学療法にて症状の消失と検査所見の正常化がみられたが, 陰嚢腫脹は遷延しMRIにて精巣内膿瘍が示唆されたため, 精巣膿瘍と診断して症例1では精巣摘除術を, 症例2では左精巣摘除術, 右精管結紮術とTUR-Pを施行し, いずれも術後は良好に経過した.2例の膿瘍内からは起炎菌の生菌が検出され, 陰嚢内の急性細菌性炎症疾患に対する抗菌化学療法後にも陰嚢腫脹が遷延する場合には精巣膿瘍を疑いMRIなどの画像検査で確認し, 早期の精巣摘除術を行う必要があると考えられた

We report two cases of testicular abscess. The first case is in a 53-year-old man who had been suffering from diabetes mellitus. Because of cerebral infarction, he had been bedridden and a Foley catheter had been indwelt for a long period of time. The second case is in a 78-year-old man who had suffered from acute prostatitis six months earlier. In both cases, the chief complaints were high fever and painful scrotal swelling. At initial evaluation, ultrasonography revealed that the affected testes were swollen without abscess formation and an ipsilateral epididymal swelling was demonstrated in the second case but not in the first case. The urine bacterial culture (UBC) result was positive for Escherichia coli in first case and Pseudomonas aeruginosa in the second case. In both cases, fever and scrotal pain subsided after antibiotic chemotherapy, and inflammatory reactions on routine blood studies were normalized within 2 weeks. Nevertheless, the swollen testes did not sigunificantly reduce in size, and testicular abscess was suspected by magnetic resonance imaging (MRI). Orchiectomy was performed, and intratesticular abscess formations were confirmed macroscopically and microscopically. In each case, bacterial culture from the abscess was positive for the same bacterium as detected from the UBC. It is difficult to distinguish testicular abscess from acute epididymitis at the early stage because of similarities on symptoms or signs between the two. If testicular swelling lasts after appropriate chemotherapy, we believe that attention should be directed to testicular abscess, which needs orchiectomy to obtain a complete cure and MRI is useful in its diagnosis.