Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient

Study design: A case report of xanthogranulomatous funiculitis and epididym o-orchitis. Xanthogranulomatous inflammation is an uncommon, non-neoplastic process characterised by destruction of tissue, which is replaced by a str iking cellular infiltrate of lipid-laden macrophages. Case report: A 21-year male sustained complete tetraplegia at C-6 level, af ter a fall in 1998. The neuropathic bladder was managed with an indwelling urethral catheter. He had many unsuccessful trials of micturition. Sixteen months after the cervical injury, he noticed swelling of the left side of t he scrotum following removal of a blocked catheter. He was prescribed antib acterial therapy. Four weeks later, physical examination revealed a hard an d irregular swelling encompassing the testis, epididymis and spermatic cord . The clinical diagnosis was epididymo-orchitis progressing to pyocele. Thr ough a scrotal incision, the swollen testis, epididymis and diseased segmen t of the spermatic cord were removed en masse. Histopathology showed extens ive areas of necrosis, with xanthogranulomatous inflammation in the spermat ic cord and to a lesser extent in the testis/epididymis. Conclusion: Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding, and subsequent interstitial extravasa tion of urine together with chronic, low-grade, suppurative infection possi bly led to development of xanthogranulomatous inflammation in the testis an d the epididymis. Since tissue destruction is a feature of xanthogranulomat ous inflammation, the definite and curative treatment is either complete (o r, where applicable, partial) excision of the affected organ in most of the cases.