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Experimental autoimmune orchitis (EAO) is a well-established rodent model of organ-specific autoimmunity associated with infertility in which the testis immunohistopathology has been extensively studied. In contrast, analysis of testis biopsies from infertile patients associated with inflammation has been more limited. In this work, testicular biopsies from patients with idiopathic non-obstructive azoospermia diagnosed with hypospermatogenesis (HypoSp) [mild: n = 9, and severe: n = 11], with obstructive azoospermia and complete Sp (spermatogenesis) (control group, C, n = 9), and from Sertoli cell-only syndrome (SCOS, n = 9) were analyzed for the presence of immune cells, spermatogonia and Sertoli cell (SCs) alterations, and reproductive hormones levels. These parameters were compared with those obtained in rats with EAO. The presence of increased CD45+ cells in the seminiferous tubules (STs) wall and lumen in severe HypoSp is associated with increased numbers of apoptotic meiotic germ cells and decreased populations of undifferentiated and differentiated spermatogonia. The SCs showed an immature profile with the highest expression of AMH in patients with SCOS and severe HypoSp. In SCOS patients, the amount of SCs/ST and Ki67+ SCs/ST increased and correlated with high serum FSH levels and CD45+ cells. In the severe phase of EAO, immune cell infiltration and apoptosis of meiotic germ cells increased and the number of undifferentiated and differentiated spermatogonia was lowest, as previously reported. Here, we found that orchitis leads to reduced sperm number, viability, and motility. SCs were mature (AMH-) but increased in number, with Ki67+ observed in severely damaged STs and associated with the highest levels of FSH and inflammatory cells. Our findings demonstrate that in a scenario where a chronic inflammatory process is underway, FSH levels, immune cell infiltration, and immature phenotypes of SCs are associated with severe changes in spermatogenesis, leading to azoospermia. Furthermore, AMH and Ki67 expression in SCs is a distinctive marker of severe alterations of STs in human orchitis.
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Although several testicular alterations promoted by coronavirus infection have been demonstrated, the extent, causes, and players of testicular pathogenesis are not totally understood. The present study aimed to investigate the short-term effects on male fertility of intranasally administered murine hepatitis virus strain 3 (MHV-3), a member of the genus Betacoronavirus, which causes a severe systemic acute infection. This mouse model might be used as a in vivo prototype for investigating the impact of betacoronavirus on the endocrine and exocrine testicular functions with the advantage to be performed in a biosafety level 2 condition. Herein, we performed virological, histopathological, and molecular studies regarding the testicular spermatogenesis and the spermatic quality analyses in an MHV-3-infected C57BL/6 mice. The main outcomes showed that MHV-3 infects mouse testis and induces a testicular inflammatory state, impairing the steroidogenic pathway. The infection led to several alterations in the testicular parenchyma, such as: seminiferous epithelium sloughing, retention of residual bodies, germ cell apoptosis, alterations in intercellular junction proteins, and worse spermatogenic parameters. Moreover, the levels of plasmatic testosterone as well as the quality of sperm production reduced. Therefore, the present data suggest that the viral/inflammatory impairment of the steroidogenic pathway and the consequent imbalance of androgen levels is critical in testicular pathology, disturbing the SC barrier function and the germ cell differentiation. Our study is important for comprehending the effects of beta coronavirus infections on testis function in order to develop treatments that could prevent virus-mediated male infertility.
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Camundongos Endogâmicos C57BL , Vírus da Hepatite Murina , Espermatogênese , Espermatozoides , Testículo , Animais , Masculino , Camundongos , Testículo/virologia , Testículo/patologia , Testículo/imunologia , Espermatozoides/virologia , Espermatozoides/imunologia , Espermatozoides/patologia , Modelos Animais de Doenças , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Infecções por Coronavirus/imunologia , Infertilidade Masculina/virologia , Infertilidade Masculina/imunologia , Infertilidade Masculina/patologia , Infertilidade Masculina/etiologia , Testosterona/sangue , HumanosRESUMO
This study included 47 free-ranging bats from the State of Minas Gerais, Brazil. Six bats (12.8%) had genital inflammatory lesions, and two of them (one Artibeus lituratus and one Glossophaga soricina, a frugivorous and a nectarivorous, respectively) were diagnosed with Brucella sp. infection through PCR, and antigens in intralesional macrophages were detected using immunohistochemistry.
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El compromiso genitourinario en una infección causada por Salmonella spp es poco frecuente, especialmente en niños. Se presenta un paciente de 40 días de vida que presentó una orquiepididimitis por Salmonella entérica serotipo Newport, con documentación microbiológica en hemocultivos, cultivo de secreción escrotal y coprocultivo. No presentó compromiso del sistema nervioso central. Un tratamiento médico y quirúrgico tempranos permitieron la evolución favorable del paciente.
Genitourinary involvement in a Salmonella spp infection is rare, especially in pediatric patients. A 40-day-old patient who presented an orchiepididymitis due to Salmonella enterica Serotype Newport is reported, with microbiological documentation in blood cultures, culture of scrotal purulent material and stool culture. There was no involvement of the central nervous system. Early medical and surgical treatment allowed the favorable evolution of the patient.
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Humanos , Masculino , Lactente , Orquite/microbiologia , Infecções por Salmonella/microbiologia , Epididimite/microbiologia , Orquite/diagnóstico , Orquite/terapia , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/terapia , Drenagem , Salmonella enterica/isolamento & purificação , Epididimite/diagnóstico , Epididimite/terapia , Antibacterianos/uso terapêuticoRESUMO
The objective of this research was to identify brucellosis by Brucella abortus and the possible risk factors associated with the transmission of the infection in dogs in the urban area of the municipality of Viçosa-AL, as well as to alert health authorities about the risk of this potential zoonosis, create a booklet to alert the population about the risks of the disease and the possibility of creating a test protocol in clinical care at the Veterinary Hospital of the Federal University of Alagoas. A study was carried out in the city of Viçosa-AL to investigate the presence of B. abortus in 30 adult male dogs. The animals that showed symptoms suggestive of reproductive disease were referred for evaluation of the hematological pattern and clinical and surgical treatment. Parallel to the blood collection, a questionnaire was applied to the owners of these dogs. Buffered acid antigen (AAT) techniques were used as a screening test and 2-Mercaptoethanol (2-ME) as a confirmatory test for AAT positives with symptoms of brucellosis. The study aimed to analyze the number of positive dogs, the clinical and anatomopathological changes and the risk factors for the occurrence of brucellosis in dogs in the municipality of Viçosa-AL. As dogs are a means of transmission for humans, health authorities must pay special attention to this disease, including the control of dogs in the Program for Control and Eradication of Brucellosis of the Ministry of Agriculture. In addition to intensifying control of vaccination and diagnosis in cattle
O objetivo desta pesquisa foi identificar a brucelose por B. abortus e os possíveis fatores de risco associados à transmissão de infecção em cães na área urbana de Viçosa-AL, bem como alertar as autoridades de saúde sobre o risco dessa potencial zoonose, criar cartilha para alertar a população sobre os riscos da doença e a possibilidade de criação de um protocolo de teste no atendimento clínico do Hospital Veterinário da Universidade Federal de Alagoas. Um estudo foi realizado no município de Viçosa-AL para investigar a presença de B. abortus em 30 cães machos adultos. As técnicas do Antígeno Acidificado Tampado (AAT) foram usadas como teste de triagem e o 2-Mercaptoetanol (2-ME) como confirmatório dos positivos para AAT com sintomas de brucelose. Dos 30 animais testados com AAT, 15 eram domiciliados e 15 semi-domesticados, nos quais 60% (9/15) e 47% (7/15) desses cães eram reativos ao soro, respectivamente. Dos 16 cães reativos séricos para AAT, apenas 25% (4/16) apresentaram sintomas e foram testados com 2- ME, sendo confirmado 100% (4/4). Nos exames anatomopatológicos, foram observadas características típicas de animais brucélicos. Somente o contato com animais da fazenda foi associado à brucelose (p <0,05), sendo considerado fator de proteção
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Animais , Masculino , Cães , Orquite/veterinária , Brucella abortus/isolamento & purificação , Brucelose/diagnóstico , Brucelose/epidemiologia , Mercaptoetanol , AntígenosRESUMO
In context of COVID-19 pandemic, there has been different presentations of the infection. The relationship of testicular pain with COVID-19 has not been extensively studied. We present a 31 years old male, with SARS-COV-2 infection, repeatedly consulting for intermittent bilateral testicular pain. Two months later he reported acute loss sensibility and pain in extremities, being diagnosed with axonal fine fiber polyneuropathy. Although the presence of SARS-COV-2 in testis remains controversial, there is a potential orchiepididymitis risk due to viral binding to ACE2 receptor in testicle, and also could induce systemic vasculitis as another possible cause of orchitis.
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BACKGROUND: Multi-organ damage is a common feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, going beyond the initially observed severe pneumonia. Evidence that the testis is also compromised is growing. OBJECTIVE: To describe the pathological findings in testes from fatal cases of COVID-19, including the detection of viral particles and antigens, and inflammatory cell subsets. MATERIALS AND METHODS: Postmortem testicular samples were obtained by percutaneous puncture from 11 deceased men and examined by reverse-transcription polymerase chain reaction (RT-PCR) for RNA detection and by light and electron microscopy (EM) for SARS-CoV-2. Immunohistochemistry (IHC) for the SARS-CoV-2 N-protein and lymphocytic and histiocytic markers was also performed. RESULTS: Eight patients had mild interstitial orchitis, composed mainly of CD68+ and TCD8+ cells. Fibrin thrombi were detected in five cases. All cases presented congestion, interstitial edema, thickening of the tubular basal membrane, decreased Leydig and Sertoli cells with reduced spermatogenesis, and strong expression of vascular cell adhesion molecule (VCAM) in vessels. IHC detected SARS-Cov-2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts in all cases. EM detected viral particles in the cytoplasm of fibroblasts, endothelium, Sertoli and Leydig cells, spermatids, and epithelial cells of the rete testis in four cases, while RT-PCR detected SARS-CoV-2 RNA in three cases. DISCUSSION AND CONCLUSION: The COVID-19-associated testicular lesion revealed a combination of orchitis, vascular changes, basal membrane thickening, Leydig and Sertoli cell scarcity, and reduced spermatogenesis associated with SARS-CoV-2 local infection that may impair hormonal function and fertility in men.
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COVID-19/complicações , Orquite/patologia , Orquite/virologia , Testículo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
Intravesical BCG therapy is effective in treating bladder cancer. Tuberculous epididymo-orchitis presents as a rare complication. There are very few cases described in which Mycobacterium Bovis produces epididymo-orchitis by itself.
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OBJECTIVE: This study investigated the effects of Tartrazine and Erythrosine (T+E) on the reproductive hormones and expression of some pro-inflammatory cytokines and testicular genes in testis of male Wistar rats. METHODS: 25 male Wistar rats (150-180g) were divided into 5 groups (n=5). Group 1 received distilled water while groups 2, 3, 4 and 5 were treated with T+E (2.5mg/kg, 5mg/kg, 10mg/kg and 20mg/kg) for the period of 23 days. Toxicity studies of the combined dye were investigated by evaluating serum reproductive hormones [Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Testosterone], gene expression and profiling, and testes histology. RESULTS: male Wistar rats (150-180g) were divided into 5 groups (n=5). Group 1 received distilled water while groups 2, 3, 4 and 5 were treated with T+E (2.5mg/kg, 5mg/kg, 10mg/kg and 20mg/kg) for the period of 23 days. Toxicity studies of the combined dye were investigated by evaluating serum reproductive hormones [Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Testosterone], gene expression and profiling, and testes histology. CONCLUSIONS: This present study reveals that the dyes could impair testicular function as evident in the up-regulation of pro-inflammatory cytokines and down-regulation of TESK-1 gene expression and architecture of the testes leading to Orchitis.
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Hormônio Foliculoestimulante , Testículo , Animais , Corantes , Citocinas/genética , Regulação para Baixo , Expressão Gênica , Masculino , Proteínas Serina-Treonina Quinases , Ratos , Ratos Wistar , Receptores do FSH , Testículo/metabolismo , Regulação para CimaRESUMO
Experimental autoimmune orchitis (EAO) is a useful model to study organ-specific autoimmunity and chronic testicular inflammation. This model reflects testicular pathological changes reported in immunological infertility in men. Progression of EAO in rodents is associated with a significantly increased percentage of testicular endothelial cells and interstitial testicular blood vessels, indicating an ongoing angiogenic process. Vascular endothelial growth factor A (VEGFA), the main regulator of physiological and pathological angiogenesis, can stimulate endothelial cell proliferation, chemotaxis and vascular permeability. The aim of this study was to explore the role of VEGFA in the pathogenesis of testicular inflammation. Our results found VEGFA expression in Leydig cells, endothelial cells and macrophages in testis of rats with autoimmune orchitis. VEGFA level was significantly higher in testicular fluid and serum of rats at the end of the immunization period, preceding testicular damage. VEGF receptor (VEGFR) 1 is expressed mainly in testicular endothelial cells, whereas VEGFR2 was detected in germ cells and vascular smooth muscle cells. Both receptors were expressed in testicular interstitial cells. VEGFR2 increased after the immunization period in the testicular interstitium and VEGFR1 was downregulated in EAO testis. In-vivo-specific VEGFA inhibition by Bevacizumab prevented the increase in blood vessel number and reduced EAO incidence and severity. Our results unveil relevance of VEGFA-VEGFR axis during orchitis development, suggesting that VEGFA might be an early marker of testicular inflammation and Bevacizumab a therapeutic tool for treatment of testicular inflammation associated with subfertility and infertility.
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Doenças Autoimunes/patologia , Neovascularização Patológica , Testículo/irrigação sanguínea , Testículo/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Inibidores da Angiogênese/farmacologia , Animais , Doenças Autoimunes/imunologia , Doenças Autoimunes/metabolismo , Doenças Autoimunes/prevenção & controle , Bevacizumab/farmacologia , Modelos Animais de Doenças , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Células Intersticiais do Testículo/metabolismo , Células Intersticiais do Testículo/patologia , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Orquite/imunologia , Orquite/metabolismo , Orquite/prevenção & controle , Codorniz/embriologia , Ratos Wistar , Transdução de Sinais , Testículo/efeitos dos fármacos , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismoRESUMO
Infection and inflammation of the male reproductive tract are relevant causes of infertility. Inflammatory damage occurs in the special immunosuppressive microenvironment of the testis, a hallmark termed testicular immune privilege, which allows tolerance to neo-antigens from developing germ cells appearing at puberty, long after the establishment of systemic immune tolerance. Experimental autoimmune orchitis (EAO) is a well-established rodent model of chronic testicular inflammation and organ specific autoimmunity that offers a valuable in vivo tool to investigate the pathological and molecular mechanisms leading to the breakdown of the testicular immune privilege. The disease is characterized by the infiltration of the interstitium by immune cells (mainly macrophages, dendritic cells, and T cells), formation of autoantibodies against testicular antigens, production of pro-inflammatory mediators such as NO, MCP1, TNFα, IL6, or activins and dysregulation of steroidogenesis with reduced levels of serum testosterone. EAO leads to sloughing of germ cells, atrophic seminiferous tubules and fibrotic remodeling, parameters all found similarly to changes in human biopsies from infertile patients with inflammatory infiltrates. Interestingly, testosterone supplementation during the course of EAO leads to expansion of the regulatory T cell population and inhibition of disease development. Knowledge of EAO pathogenesis aims to contribute to a better understanding of human testicular autoimmune disease as an essential prerequisite for improved diagnosis and treatment.
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Doenças Autoimunes/imunologia , Orquite/imunologia , Animais , Humanos , MasculinoRESUMO
The aim of this work was to study effects of ketotifen fumarate (KF) on prevention of tissue damage in testes of rats with experimental autoimmune orchitis (EAO) and on the contralateral testis in a model of prolonged testicular cord torsion (TCT). Rats with EAO or TCT were injected intraperitoneally once daily with KF or saline solution (vehicle group). Incidence and severity of testicular damage were evaluated by histopathology using an EAO score or a Johnsen score. Mast cells (MC) were identified by histochemistry and quantified. In EAO model, KF significantly reduced severity of histopathological testicular damage compared to rats in the vehicle group. KF also reduced the number of testicular MC compared to vehicle group. Similarly, in TCT model, multifocal damage of the contralateral testis was observed 30 days after testicular torsion characterized by sloughing of the germinal epithelium, seminiferous tubule atrophy, and interstitial edema. Focal signs of inflammation and fibrosis of seminiferous tubular walls were also observed. In contrast, sections of contralateral testis of rats injected with KF and killed 30 days after surgery showed normal histological features. A significant decrease in the number of MC was observed in rats treated with KF compared to untreated animals. In conclusion, we demonstrated that treatment with KF reduced testicular inflammatory process and MC infiltrates in both EAO and TCT models. The results suggest a promising treatment for infertile male patients with testicular pathologies associated with inflammation and germ cell loss.
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Doenças Autoimunes/patologia , Epididimite/patologia , Antagonistas dos Receptores Histamínicos H1/farmacologia , Cetotifeno/farmacologia , Mastócitos/efeitos dos fármacos , Orquite/patologia , Torção do Cordão Espermático/patologia , Testículo/efeitos dos fármacos , Animais , Doenças Autoimunes/imunologia , Contagem de Células , Epididimo/efeitos dos fármacos , Epididimo/imunologia , Epididimo/patologia , Epididimite/imunologia , Hipersensibilidade Tardia , Imunidade Celular/efeitos dos fármacos , Masculino , Mastócitos/imunologia , Mastócitos/patologia , Orquite/imunologia , Ratos , Índice de Gravidade de Doença , Torção do Cordão Espermático/imunologia , Testículo/imunologia , Testículo/patologia , VacinaçãoRESUMO
Xanthogranulomatous orchitis is a rare, non-neoplastic inflammatory condition. We present a case of a 55-year-old diabetic male with an increase in volume, pain and edema in right testicle with a one-year history. The examination involved the investigation of inflammatory markers and ultrasound. Exploration of the scrotum revealed important destruction of the tissue architecture. This case underscores the importance of including xanthogranulomatous orchitis in the differential diagnosis of a testicular lump.
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Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Early and accurate diagnosis is therefore imperative. Ultrasound is the method of choice for the initial evaluation of this vast range of conditions, because it is a rapid, ionizing radiation-free, low-cost method. Despite the practicality and accuracy of the method, which make it ideal for use in emergency care, the examiner should be experienced and should be familiarized with the ultrasound findings of the most common inguinoscrotal diseases. On the basis of that knowledge, the examiner should also be able to make an accurate, direct, precise report, helping the emergency room physician make decisions regarding the proper (clinical or surgical) management of each case. Here, we review most of the inguinoscrotal conditions, focusing on the imaging findings and discussing the critical points for the appropriate characterization of each condition.
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Abstract Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Early and accurate diagnosis is therefore imperative. Ultrasound is the method of choice for the initial evaluation of this vast range of conditions, because it is a rapid, ionizing radiation-free, low-cost method. Despite the practicality and accuracy of the method, which make it ideal for use in emergency care, the examiner should be experienced and should be familiarized with the ultrasound findings of the most common inguinoscrotal diseases. On the basis of that knowledge, the examiner should also be able to make an accurate, direct, precise report, helping the emergency room physician make decisions regarding the proper (clinical or surgical) management of each case. Here, we review most of the inguinoscrotal conditions, focusing on the imaging findings and discussing the critical points for the appropriate characterization of each condition.
Resumo As emergências envolvendo a região inguinal e o escroto são frequentes, derivadas de diferentes causas, e na maioria das vezes apresentam-se clinicamente de modo não específico e bastante dolorosas. Algumas destas condições apresentam elevado potencial de gravidade, sendo imperioso um diagnóstico rápido e preciso. A ultrassonografia é, indiscutivelmente, o método de escolha na avaliação inicial de todo o vasto leque de doenças nessas regiões, sendo rápido, de baixo custo e sem uso de radiação. Além da praticidade e acurácia do método, ideal para a prática em âmbito de pronto-atendimento, a experiência do examinador, o qual deve estar familiarizado com os principais achados de imagem, é fundamental para a precisão diagnóstica. Some-se a isto a necessidade de um relatório claro e assertivo, auxiliando o médico emergencista na terapêutica apropriada a cada caso, seja clínica ou cirúrgica. Procuramos trazer uma revisão baseada nos achados de imagem das principais afecções dolorosas inguinais e escrotais, discutindo os pontos-chaves para sua adequada caracterização.
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Abstract Although histoplasmosis is generally a self-limited disease, disseminated infection can occur in patients lacking effective cell-mediated immunity, reaching virtually every organ, even the genitourinary tract in rare cases. We report a case of epididymo-orchitis in an immunocompetent 38-year-old bricklayer from the rural area of Villeta, Cundinamarca, Colombia. The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confirmation of Histoplasma capsulatum.
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Animais , Triatominae/classificação , Abreviaturas como Assunto , Insetos Vetores/classificaçãoRESUMO
ABSTRACT Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.
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Humanos , Masculino , Pessoa de Meia-Idade , Progressão da Doença , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Evolução Fatal , Hospedeiro Imunocomprometido , Tuberculose dos Genitais Masculinos/patologia , Tuberculose Pulmonar/patologiaRESUMO
Neonatal epididymo-orchitis is a rare condition, causing testicular pain in neonatal boys. It represents epididymo-testicular inflammation which commonly coexists with urinary tract infections and malformations. The idiopathic type is extremely rare. We present a case of a seven-day old male neonate with advanced septic form of idiopathic orchiepididymitis and no associated urinary tract anomalies. The boy was hospitalized with signs of sepsis, anterior abdominal wall phlegmona and bilateral acute scrotum. Colour Doppler echosonography indicated epididymo-testicular inflammation with increased vascular flow. The patient underwent surgical exploration of both scrota in order to evacuate purulent content and fibrin. Cultures of Enterobacter spp were detected in hemiscrotal pus. Prompt administration of antibiotics was done. The postoperative course was uneventful. We suggest that every male baby must be very meticulously examined by a neonatologist in the early postnatal period, in order to prevent infertility.
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Acute Hemorrhagic Edema of Infancy (AHEI) is a rare leukocytoclastic vasculitis, clinically characterized by the classical triad: palpable purpuric skin lesions, edema and fever, and is commonly misdiagnosed as Henoch-Schönlein purpura. In addition to its sudden onset, AHEI is also characterized by its self-limited course with complete and spontaneous recovery occurring between 1 and 3 weeks. Because of the scarcity of studies on therapy with corticosteroids, the conservative approach is usually recommended. The authors report an unusual case of an one-year-old boy who presented with typical cutaneous rash of AHEI and orchitis, the latter showing complete resolution after less than 24 hours of prednisolone therapy. The authors call attention to this entity mainly as a differential diagnosis of Henoch-Schönlein purpura and to the importance of new studies to establish the benefits of corticosteroid therapy for AHEI.
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La afectación osteoarticular es la complicación más frecuente de la brucelosis. La espondilodiscitis es una complicación grave, ya que suele estar asociada con la formación de abscesos. Se presenta el caso de un varón de 43 años de edad, natural de Marruecos, con síntomas, signos y hallazgos imagenológicos de espondilodiscitis de larga evolución, orquitis y endocarditis. Mediante la realización de pruebas de laboratorio complementarias se llega al diagnóstico de infección por Brucella spp. El presente caso busca concientizar a la comunidad médica sobre la importancia de considerar la infección por Brucella spp. como diagnóstico diferencial en pacientes con sospecha de espondilodiscitis infecciosa, especialmente en aquellos pacientes con antecedentes epidemiológicos, permitiendo así realizar un acertado y oportuno diagnóstico. Este caso resulta interesante porque nunca antes se había descrito la presencia simultánea de estas tres manifestaciones de la brucelosis en un paciente inmuno competente. (Acta Med Colomb 2015; 40: 166-168).
Osteoarticular involvement is the most common complication of brucellosis. Spondylodiscitis is a serious complication as it is often associated with abscess formation. The case of a 43 years old man born in Morocco with symptoms, signs and imaging findings of longstanding spondylodiscitis, orchitis and endocarditis is presented. Through the implementation of complementary laboratory tests, diagnosis infection by Brucella spp. was made.This case aims to raise awareness in the medical community about the importance of considering Brucella spp. as a differential diagnosis in patients with suspected infectious spondylodiscitis, especially in those patients with epidemiological background, allowing make a successful and timely diagnosis. This case is interesting because never before had been described the simultaneous presence of these three manifestations of brucellosis in an immunocompetent patient. (Acta Med Colomb 2015; 40: 166-168).