trimethoprim--sulfamethoxazole-drug-combination and Epididymitis

A case of epididymo-orchitis due to Nocardia asteroides in a liver transplant recipient is reported. Nocardiosis is an extremely rare cause of epididymo-orchitis. Four other cases published in the English language medical literature are reviewed. All patients were immunocompromised, and other organs were affected simultaneously. Clinically the infection presented as a painful enlargement of the testicle with few inflammatory signs. Mortality was high (3/5), and in the two survivors long-term sulfonamide therapy was combined with orchiectomy. Nocardiosis should be considered in the diagnosis of epididymo-orchitis in the immunocompromised host.

Topics: Adult; Aged; Anti-Bacterial Agents; Epididymitis; Humans; Immunocompromised Host; Liver Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Orchiectomy; Orchitis; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacteria; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Epididymitis; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Neck Obstruction; Urinary Tract Infections; Urine

We report a case of epididymo-orchitis and central nervous system nocardiosis in a 22-year-old man with T-cell acute lymphoblastic leukemia; he was an allogeneic marrow recipient with acute and chronic graft-versus-host disease.. He had microscopic hematuria and cytomegalovirus antigenemia. He deteriorated subsequently while on cyclosporine and steroids, requiring hospital admission owing to fever and swelling of the left testis and generalized tonic-clonic convulsions.. Brain magnetic resonance imaging showed abnormal signal area in right parietal and left parieto-occipital lobes. The lesions had mass effect, edema, and ring enhancement. Findings were indicative of a brain abscess. A testicular biopsy from the lower pole of the left testis was done. A white-to-yellowish discharge was seen and subsequently, Nocardia grew in culture.. Trimethoprim-sulfamethoxazole was prescribed, and significant improvement was seen after 2 weeks. The patient was discharged. He was subsequently referred after 3 weeks due to graft-versus-host disease and died of pancytopenia.

Topics: Acute Disease; Anti-Infective Agents; Bone Marrow Transplantation; Brain Abscess; Chronic Disease; Epididymitis; Epilepsy, Tonic-Clonic; Fatal Outcome; Graft vs Host Disease; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Nocardia Infections; Orchitis; Pancytopenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Adult; Ciprofloxacin; Drug Combinations; Epididymitis; Humans; Male; Orchitis; Salmonella Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination