Orchiepididymitis in the context of MIS in a child with Covi
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A 7-year-old boy without remarkable medical history presented to our hospital on December 2020 complaining of high fever (40°C) for more than 3 days, abdominal pain, loss of appetite, general fatigue and bilateral testicular discomfort developing over the past 2 days. At first, acute appendicitis was suspected but was later excluded. On physical examination he had reddish congested oral mucosa, dry cracked lips, pallor, generalized abdominal pain spreading to the iliac fossae, diffuse abdominal tenderness, generalized myalgias, sporadic erythematic rash in the inguinal region, the axilla and on the extremities.

There was left-sided scrotal redness, increased warmth and swelling with testicular tenderness and pain which were worse on the left testis and was relieved with elevation, suggesting acute orchiepididymitis. This was confirmed upon consultation with the Urology department, in the absence of trauma.

Laboratory evaluation revealed lymphopenia, CRP:131 mg/L. Urinalysis was normal. Chest X-ray was normal. Abdominal ultrasonography showed a small amount of free peritoneal effusion located in the right iliac cavity and a small amount of clear fluid effusion in the scrotum, multiple hypoechogenic spots in the testis, and oedema in the epididymis with enlarged edematous epididymal caput.

The patient was transferred to the Pediatric Intensive Care Unit as he became hemodynamically unstable. Echocardiography showed pleural and pericardial inflammatory reactions. Computerized Tomography of the chest revealed minor alveolar infiltrations in the lower lobes. Differential Diagnosis was mostly suggestive of MIS-C infection with a very rare manifestation, orchiepididymitis. The school our patient attends documented an outbreak of SARS-Cov-2 infections.

Extended laboratory evaluations were consistent with MIS-C, D-dimer: 9400 ng/ml, procalcitonin: 29.8 ng/ml, Ferritin: 757 ng/ml, Antistreptolysine-O: 102tood units/ml, nasopharyngeal swab (real-time PCR) was positive for SARS-CoV2. The patient was treated as recommended by CDC and WHO Guidelines with Ceftriaxone, Vancomycin, Methylprednisolone (2 mg/kg/day) for 5 days, then Prednisolone for 3 weeks, PPI: Omeprazole IV 1 mg/kg/12 h, IVIG (2 g/kg), Aspirin, Enoxaparin Sodium, Dopamine and Acetaminophen.

On Day 3 of hospitalization, symptoms started improving after 12 h of IVIG administration as the generalized pain was lessened, scrotal pain and discomfort decreased gradually. On Day 6, the patient was afebrile, hemodynamically stable and pain-free. Enoxaparin was continued until discharge on Day 10 with a normal blood panel, abdominal and testicular ultrasonography.

Source: https://academic.oup.com/omcr/article/2021/7/omab052/6324929
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