Sonography of Multifocal Brucella Orchitis

Introduction

Brucellosis is a zoonosis caused by different species of Brucella, a genus of gram negative coccobacilli. It is transmitted to humans mainly by direct contact with infected animals or their secretions, or via the ingestion of unpasteurised dairy products. The disease presents with nonspecific symptoms and may affect any organ or system of the body. The incidence of genitourinary involvement lies in the range of 2 – 20 %, mainly affecting the testis, the epididymis, or both. Ultrasonography serves as the main imaging modality for detecting testicular pathology in patients with brucella infection. In cases of orchi-epididymal brucella, the sonographic findings may display a diffuse or focal pattern (Patel PJ et al. Sonographic findings in scrotal brucellosis. J Clin Ultrasound 1988; 16: 483 – 486; Bayram MM et al. Scrotal gray-scale and color Doppler sonographic findings in genitourinary brucellosis. J Clin Ultrasound 1997; 25: 443 – 447; Salmeron I et al. Granulomatous epididymo-orchitis: sonographic features and clinical outcome in brucellosis, tuberculosis and idiopathic granulomatous epididymo-orchitis. J Urol 1998; 159: 954 – 957) which usually regresses after initiation of antimicrobial therapy. The focal presentation is relatively rare, and one should bear in mind that testicular malignancy, amongst other conditions, may have a similar sonographic appearance, and the physician must therefore establish an accurate diagnosis in order to prevent unnecessary orchiectomy. We present the case of a 15-year-boy with multifocal brucellar epididymo-orchitis who did not respond to antibiotic treatment and therefore required orchiectomy.