Chlamydia trachomatis infection mimicking testicular malignancy in a young man

Chlamydia Trachomatis Masquerading as Scrotal Masses in Adolescents

OBJECTIVE

To present a case series of 3 post-pubertal adolescent males with Chlamydia trachomatis presenting as scrotal masses. Scrotal masses are worrisome for malignancy, especially when imaging confirms intratesticular lesions. However, there are benign conditions which may mimic testicular cancer. Some of these conditions may not be readily considered in the pediatric population. This phenomenon is rare in the pediatric population, and this represents only the second report in the literature of this finding.

METHODS

Three cases of adolescent males who presented with a scrotal mass were reviewed. Traditional work up was performed, and results are reviewed.

RESULTS

Median age for these patients was 16 years (range 16-17). All patients underwent scrotal ultrasound confirming intratesticular lesions. Two of the 3 patients denied sexual activity within the past year. Two patients underwent orchiectomy after counseling and shared decision making, with both specimens demonstrating no malignancy. All 3 patients were eventually diagnosed with Chlamydia trachomatis and treated with appropriate antibiotic therapy.

CONCLUSION

Adolescent males who are sexually active can present with Chlamydia trachomatis infection masquerading as a scrotal mass. It is important to consider infectious etiologies in this patient group as it has been documented that many adolescents are hesitant to admit to sexual activity. Thus, routine sexually transmitted infection (STI) screening warrants consideration, and testicular preservation should be sought when it is a viable management option.

Scrotal mass with fever and generalized lymphadenopathy in a young man secondary to Chlamydia trachomatis infection

A young man presented with systemic upset and generalised lymphadenopathy. Later, it transpired that he was under investigation for a scrotal mass. Investigations were carried out to ascertain the cause of his symptoms including lymph node biopsy. Because of the presence of a scrotal mass in a sexually active male, a urinary Chlamydia ligase chain reaction (LCR) test was carried out. The result was positive and he was treated with doxycycline for 2 weeks. His symptoms settled and further, the urinary LCR was negative. We propose that Chlamydia trachomatis infection caused his illness and that urine PCR or LCR tests for Chlamydia is a convenient and useful investigation in sexually active males with generalised lymphadenopathy and fever of unknown origin.

Chlamydia trachomatis disguised as an asymptomatic scrotal mass in adolescents

We present two cases of adolescents who presented with painless scrotal masses suggestive of testicular cancer. Diagnostic workup of both these patients revealed Chlamydia trachomatis and both patients were successfully treated with doxycycline. Both patients initially denied sexual activity. We suggest that a high index of suspicion is warranted in adolescent patients that present with asymptomatic scrotal masses and precise tests for C. trachomatis be done to rule out an infectious cause.