COVID-19: Male Patients can present with testicular pain – Medical Report
Though a novel virus, COVID-19 is now the most talked about disease globally and the symptoms and signs at presentation seems to be evolving by the day as frontline healthcare workers have consistently reported new symptoms and signs apart from the usual cough, catarrh, running stomach, loss of taste and smell, headaches, and conjuctivitis (redness of the eyes) etc.
This time, the new symptoms discovered in a 42 year man who tested positive for COVID-19 were testicular and abdominal pains according to reports published by the American Journal of Emergency Medicine.
Below is the case report
CASE REPORT
“A 42 year-old-male was referred by his primary care physician (PCP) to the ED for further evaluation of 8 days of abdominal, testicular, and back pain.
The patient originally presented to his PCP’s office one week prior, where he was diagnosed with constipation and sent home on a bowel regimen. The pain intermittently continued with waxing and waning severity for 8 days prompting his ED presentation.
The patient described his symptoms as a constant stabbing pain that originated from his groin and migrated to his abdomen, flank, back, and chest.
Additionally, he reported subjective fevers two days before presentation. On review of systems, he denied any rhinorrhea, sore throat, cough, shortness of breath, nausea or vomiting.
On arrival to the ED, the patient was afebrile and hemodynamically stable. The physical exam revealed diffuse abdominal tenderness without guarding or rebound and the testicular exam revealed no abnormal findings.
The remainder of the patient’s physical exam was otherwise normal. Standard blood work, a chest radiograph and abdominal CT scan were obtained.
The patient’s blood laboratory values were benign including a normal white blood count. His chest radiograph revealed no abnormal findings as read by radiology.
The CT of his abdomen and pelvis captured the lung bases which revealed pulmonary ground glass opacification and consolidation consistent with pneumonia in addition to possible colitis of the sigmoid and distal descending colon.
The patient was subsequently started on cefpodoxime and azithromycin for treatment of both his colitis and pneumonia and discharged home with instruction to follow up with his PCP.
Two days later, the patient’s PCP telephoned the primary ED team to notify the team that the patient had tested positive for COVID-19.
The team was notified that one day prior to his ED visit, the patient had received COVID-19 testing due to his attendance at a biotechnology conference two weeks prior that was known to be the nidus of the Massachusetts outbreak.
On the day of his ED visit, the patient had been seated in the waiting room for 2 h prior to being roomed. Unfortunately, full PPE was never donned prior to his examination.”
Conclusion
Asymptomatic and atypical presentations of COVID-19 like abdominal and testicular pain have been described, but the frequency is unknown. Healthcare workers need to be vigilant of atypical presentations of COVID-19 and consider full PPE for all patients as community spread increases.
However, the main sources of testicular pain are: torsion testes, testicular cancer, kidney stones, epididymo-orchitis, inguinal hernia, varicocele and trauma.
Having a high index of suspicion is key.
