Unilateral Epididymo-Orchitis With Complicated Urinary Tract Infection: A Clue to Underlying Vesicoureteral Reflux

Epididymo-orchitis (EO) is rare in infants, and associated hydrocele at presentation indicates an advanced stage of infection. It is commonly associated with urinary tract infection (UTI) and can be a clue to the presence of underlying congenital anomalies of the kidney and urinary tract. Testicular torsion is a surgical emergency that can mimic EO and should be ruled out at presentation. Here, we present a six-month-old male infant who was brought in with complaints of passage of pinkish urine, pus discharge per urethra for two days, and fever for one day. He also had a history of excessive crying during micturition for the past seven days. On examination, he was febrile, and head-to-toe examination revealed an acute left scrotum with hydrocele. Prehn's sign was negative on the left side, and the cremasteric reflex was absent bilaterally. Urinalysis was ordered along with culture, which showed plenty of pus cells and a few red blood cells. Ultrasound with Doppler (USG Doppler) was done immediately, which ruled out torsion and hernia but showed an inflamed epididymis and left mild hydronephrosis (HDN) with trabeculated bladder wall and internal echoes. The infant was started on intravenous (IV) antibiotics for suspected UTI with poor oral intake, and he promptly improved in the next 48 hours. Urine culture grew <i>Escherichia coli, </i>and an antibiotic course was given for 10 days. A follow-up micturating cystourethrogram (MCU) revealed grade III left side vesicoureteral reflux (VUR), for which he was started on antibiotic prophylaxis, and his technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) scan was normal. He is currently under periodic follow-up for his VUR. This case emphasizes the timely detection of complicated UTIs in infants. Torsion should always be ruled out in infants presenting with acute scrotum.