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Acute epididymo-orchitis due to Hemophilus influenzae type b
Volume 91 Number 4
Letters to the Editor
685
Editorial correspondence
"Editorial Correspondence" o r letters to the Editor relative to articles published in the JOURNALor to topics of current interest are subject to critical review and to current editorial policy in respect to publication in part or in full.
Acute epididymo-orchitis due to Hemophilus influenzae type b To the Editor: Waldman and associates ~ recently described two children under age two years with acute epididymo-orchitis due to Hemophilus influenzae type b. We describe here the fourth reported case which occurred in a 6-month-old boy. CASE REPORT Patient J. P. was admitted 9/7/76 following 24 hours of fever, fight testicular swelling, pain, and scrotal erythema. Positive findings on examination included a toxic appearance, temperature of 40~ respirations of 68, and a tender, red, edematous right scrotum, testicle, and spermatic cord. Laboratory data included a helmoglobin of 10.6 gm/dl and White blood count of 3,700/mm :~, with 31% segmented neutrophils, 10% bands, 55% lymphocytes, 4% monocytes, and adequate platelets. A left upper lobe infiltrate was present on chest roentgenogram. Clear fluid containing a few polymorphonuclear leukocytes and pleomorphic gram-~aegative rods was aspirated from the scrotum and testicular mass. At surgery, the entire spermatic cord, epididymis, and testicle were swollen, the testicle was deep purple-blue, and there was no torsion. Incision of the testicle was followed by rapid improvement in color. No necrosis of the seminiferous tubules was noted on the frozen section although testicular infarction was described in the final report. A lumbar puncture performed immediately following surgery revealed cerebrospinal fluid (CSF) which contained 1,222 leukocytes/mm' with 11% lymphocytes and 89% segmented neutrophils; 6 erythrocytes; protein 270 mg/dl; and glucose 58 mg/dl. The blood glucose was 152 mg/dl. H. influenzae type b, sensitive to ampicillin by disc susceptibility testing, grew from blood, CSF, and testicular cultures. Following ten days of intravenous ampicillin at 300 mg/kg/ day the scrotal incision healed well and the child has remained asymptomatic since discharge. DISCUSSION Percutaneous testicular aspiration may be of help in identifying the organism and in differentiating between torsion and
acute infection.-' Surgery may still be necessary to prevent infarction by relieving testicular swelling. P. Joan Chesney, M.D, Department of Pediatrics University of Wisconsin Hospi'tals 1300 University A re. Madison, WI 53706 Thomas N. Saari, M.D. Gustave Mueller, M.D, Madison General Hospital 202 South Park St. Madison, W I 53715 REFERENCES 1. Waldman LS, Kosloske AM, and Parsons DW: Acute epididymo-orchitis as the presenting manifestation of Hemophilus influenzae septicemia, J PEDIATR90:87, 1977. Morgenlander HL, and Wise GJ: Scrotal aspiration: aid in early differentiation between torsion of spermatic cord and acute epididymo-orchitis, Urology 4:686, 1974.
Treatment of nephrotic syndrome in infants To the Editor: Kohaut and Hill' recommend that cyclophosphamide be considered in the management of infantile nephrotic syndrome (INS) in their report of three such patients. A recent case at our hospital demonstrates that the natural history of INS is unpre5 dictable and that conservative therapy may often be more appropriate. CASE REPORT A 51/2-month-old girl developed periorbital edema progressing to anasarca. The family history was negative for Finnish ancestry or nephrotic syndrome. On physical examination, blood Pressure ranged up to 140 systolic. There was generalized edema With ascites. Urine examination revealed occasional red blood cells with no cellular casts and 4+ protein. Serum albumin was 0.9
Letters to the Editor
685
Editorial correspondence
"Editorial Correspondence" o r letters to the Editor relative to articles published in the JOURNALor to topics of current interest are subject to critical review and to current editorial policy in respect to publication in part or in full.
Acute epididymo-orchitis due to Hemophilus influenzae type b To the Editor: Waldman and associates ~ recently described two children under age two years with acute epididymo-orchitis due to Hemophilus influenzae type b. We describe here the fourth reported case which occurred in a 6-month-old boy. CASE REPORT Patient J. P. was admitted 9/7/76 following 24 hours of fever, fight testicular swelling, pain, and scrotal erythema. Positive findings on examination included a toxic appearance, temperature of 40~ respirations of 68, and a tender, red, edematous right scrotum, testicle, and spermatic cord. Laboratory data included a helmoglobin of 10.6 gm/dl and White blood count of 3,700/mm :~, with 31% segmented neutrophils, 10% bands, 55% lymphocytes, 4% monocytes, and adequate platelets. A left upper lobe infiltrate was present on chest roentgenogram. Clear fluid containing a few polymorphonuclear leukocytes and pleomorphic gram-~aegative rods was aspirated from the scrotum and testicular mass. At surgery, the entire spermatic cord, epididymis, and testicle were swollen, the testicle was deep purple-blue, and there was no torsion. Incision of the testicle was followed by rapid improvement in color. No necrosis of the seminiferous tubules was noted on the frozen section although testicular infarction was described in the final report. A lumbar puncture performed immediately following surgery revealed cerebrospinal fluid (CSF) which contained 1,222 leukocytes/mm' with 11% lymphocytes and 89% segmented neutrophils; 6 erythrocytes; protein 270 mg/dl; and glucose 58 mg/dl. The blood glucose was 152 mg/dl. H. influenzae type b, sensitive to ampicillin by disc susceptibility testing, grew from blood, CSF, and testicular cultures. Following ten days of intravenous ampicillin at 300 mg/kg/ day the scrotal incision healed well and the child has remained asymptomatic since discharge. DISCUSSION Percutaneous testicular aspiration may be of help in identifying the organism and in differentiating between torsion and
acute infection.-' Surgery may still be necessary to prevent infarction by relieving testicular swelling. P. Joan Chesney, M.D, Department of Pediatrics University of Wisconsin Hospi'tals 1300 University A re. Madison, WI 53706 Thomas N. Saari, M.D. Gustave Mueller, M.D, Madison General Hospital 202 South Park St. Madison, W I 53715 REFERENCES 1. Waldman LS, Kosloske AM, and Parsons DW: Acute epididymo-orchitis as the presenting manifestation of Hemophilus influenzae septicemia, J PEDIATR90:87, 1977. Morgenlander HL, and Wise GJ: Scrotal aspiration: aid in early differentiation between torsion of spermatic cord and acute epididymo-orchitis, Urology 4:686, 1974.
Treatment of nephrotic syndrome in infants To the Editor: Kohaut and Hill' recommend that cyclophosphamide be considered in the management of infantile nephrotic syndrome (INS) in their report of three such patients. A recent case at our hospital demonstrates that the natural history of INS is unpre5 dictable and that conservative therapy may often be more appropriate. CASE REPORT A 51/2-month-old girl developed periorbital edema progressing to anasarca. The family history was negative for Finnish ancestry or nephrotic syndrome. On physical examination, blood Pressure ranged up to 140 systolic. There was generalized edema With ascites. Urine examination revealed occasional red blood cells with no cellular casts and 4+ protein. Serum albumin was 0.9