The case report was written by Retno Hernik Mulyati Andayani and Annisa Dewi Maharani and published in the Asian Journal of Healthcare Analytics.
The researchers described the case of a five-day-old male newborn who developed severe swelling of the right scrotum alongside signs of systemic infection. Although epididymitis is relatively common in older boys and adolescents, it is extremely rare in newborns, accounting for less than one percent of acute scrotal conditions in neonates.
Symptoms Appeared During Hospital Treatment
According to the report, the baby was initially admitted for respiratory distress syndrome and neonatal jaundice. He was born at full term but had a history of perinatal asphyxia, a condition caused by oxygen deprivation during birth.
On the second day of hospitalization, the infant suddenly developed a fever of 38.2 degrees Celsius, tachycardia, and swelling of the right side of the scrotum accompanied by redness and tenderness.
Laboratory tests revealed significant leukocytosis with a white blood cell count of 27,260/mm³ and elevated C-reactive protein levels of 21 mg/L, indicating inflammation and infection. However, blood and urine cultures showed no bacterial growth.
Doctors then performed a color Doppler ultrasound, which revealed increased blood flow and enlargement of the epididymis in the right testis, findings consistent with epididymitis.
According to Retno Hernik Mulyati Andayani and colleagues, Doppler ultrasound played a crucial role in distinguishing epididymitis from testicular torsion.
“Increased vascularity on ultrasonography supported the diagnosis of epididymitis and helped avoid unnecessary surgical intervention,” the authors explained.
Rare Condition Often Mimics Testicular Torsion
Epididymitis is an inflammation of the epididymis, a small coiled tube located behind the testicle that stores and transports sperm. In older children and adolescents, the condition is commonly caused by urinary tract infections that spread upward through the reproductive tract.
In neonates, however, the mechanism is different. The researchers explained that neonatal epididymitis is usually linked to systemic infections that spread through the bloodstream rather than ascending urinary infections.
Because newborn immune systems are still immature, bacteria can spread more easily to organs with rich blood supply, including the epididymis.
One of the biggest diagnostic challenges is that neonatal epididymitis presents symptoms almost identical to testicular torsion. Both conditions can cause swelling, redness, and pain in the scrotum.
The consequences of misdiagnosis can be serious. Testicular torsion requires immediate surgery to restore blood flow and save the testicle, while epididymitis is generally treated conservatively with antibiotics.
“Delayed or inaccurate diagnosis may result in unnecessary surgery or irreversible testicular loss,” the researchers noted.
Intensive Antibiotic Therapy Led to Recovery
Doctors initially treated the newborn with ampicillin and gentamicin. However, the infant’s condition worsened, prompting escalation to broader-spectrum antibiotics, meropenem and amikacin.
Following the change in treatment, the baby showed significant clinical improvement. The fever subsided, and the scrotal swelling gradually resolved.
The patient completed a two-week course of antibiotics and recovered without requiring surgical intervention.
The case demonstrates that early recognition and appropriate imaging can prevent unnecessary operations in neonatal patients with acute scrotal swelling.
Doppler Ultrasound Considered Essential
The researchers emphasized that color Doppler ultrasonography should be considered an essential diagnostic tool in neonatal acute scrotum cases.
This imaging method allows doctors to evaluate blood flow in the testicles. In epididymitis, blood flow typically increases due to inflammation. In contrast, testicular torsion is characterized by reduced or absent blood flow.
These differences are critical in determining whether emergency surgery is required.
The study also highlighted that negative blood and urine cultures do not rule out infection in newborns. Neonatal infections may still be present despite the absence of detectable bacteria in laboratory cultures.
Implications for Neonatal Healthcare
The findings highlight the need for greater awareness among pediatricians, neonatologists, emergency physicians, and radiologists regarding neonatal epididymitis as a potential cause of acute scrotal swelling.
Improved clinical recognition may help reduce unnecessary surgeries, shorten diagnostic delays, and prevent permanent complications.
The report also reinforces the importance of Doppler ultrasound availability in hospitals providing neonatal intensive care services.
For medical education and pediatric research, the case contributes valuable evidence to the limited global literature on neonatal epididymitis, especially from Indonesia.
Author Profiles
dr. Retno Hernik Mulyati Andayani is a pediatrician from the Department of Child Health at Haji Hospital of East Java. Her work focuses on neonatal health, pediatric infections, and acute pediatric care.
Annisa Dewi Maharani is a researcher from the Faculty of Medicine at Muhammadiyah Surabaya University with research interests in pediatric and neonatal medicine.
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