Haemophilus influenzae-induced epididymitis: a rare case report.

Introduction and importance: Epididymitis is a common urological condition typically caused by Chlamydia trachomatis or Neisseria gonorrhoeae, with rare complications like abscess formation. Haemophilus influenzae, usually linked to respiratory infections, is an uncommon cause. This report discusses a 33-year-old male with H. influenzae epididymitis, bacteremia, and a positive NAAT for Chlamydia, presenting a rare and complex clinical scenario. His history of vasectomy adds further intricacy to the case. This highlights the importance of recognizing atypical pathogens, conducting thorough diagnostic evaluations, and tailoring management strategies for unusual presentations of epididymitis.

Case presentation: A 33-year-old male with GERD and a history of vasectomy presented with 1 day of fevers, chills, and worsening left-sided scrotal pain. Examination showed localized scrotal tenderness and a temperature of 100.9°F. Blood cultures revealed H. influenzae, and NAAT confirmed Chlamydia with negative Gonorrhea testing. Ultrasound suggested epididymitis with a possible abscess, while CT showed scrotal edema without a drainable collection. Follow-up imaging maintained concerns for an abscess. Treated with Rocephin and Doxycycline, the patient showed clinical improvement, with plans for serial imaging to monitor resolution and ensure full recovery.

Clinical discussion: This case highlights the challenges of managing epididymitis caused by the atypical pathogen H. influenzae. Rare in genitourinary infections, its detection raises questions about pathogenesis, possibly linked to the patient's vasectomy altering local immunity. Co-infection with Chlamydia may have exacerbated localized inflammation. Serial imaging, particularly ultrasound, proved critical in identifying an abscess overlooked by CT. Management involved targeted antibiotics, careful monitoring of blood cultures, and follow-up imaging to prevent complications. The case underscores the importance of a broad differential diagnosis and tailored treatment in managing rare presentations of epididymitis.

Conclusion: This report highlights a rare case of H. influenzae-induced epididymitis with bacteremia and co-existing Chlamydia infection in a post-vasectomy patient. It underscores the importance of recognizing uncommon pathogens, especially in patients with unique risk factors like vasectomy. Serial imaging was crucial for identifying complications such as abscess formation. Early diagnosis and targeted therapy were essential in preventing serious outcomes like chronic inflammation or abscess rupture. This case contributes to the limited literature on atypical epididymitis, emphasizing the need for a multidisciplinary approach in managing complex infections effectively.