BACKGROUND: Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis.
METHODS: We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient\'s condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis.
CONCLUSIONS: To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.

A scrotal abscess following perforated appendicitis is a rare complication. This is mostly seen in children and usually occurs due to the presence of the patent processus vaginalis, which permits the passage of pus from the intra-abdominal cavity down to the scrotum, resulting in a scrotal pyocele. There are few reported cases of such complications in young adult patients. We report a case of a 50-year-old male with a scrotal pyocele following exploratory laparotomy for perforated appendicitis. Scrotal ultrasound (US) findings were suggestive of a right-sided scrotal abscess, and the CT scan showed prominent fat in the proximal part of the right inguinal canal, which suggested the presence of a partially patent processus vaginalis. Our case is the first reported in the middle-aged group, and our review of the literature is the first directed to the adult age group. This review emphasizes the importance of considering scrotal pyocele in any patient with acute scrotum post-appendectomy, regardless of the patient\'s age, the affected side, and the presence or absence of identifiable patent processus vaginalis, as it may be microscopically permeable. Treatment will entail urgent drainage of the abscess, together with a course of antibiotics.

A 25 year old male presented with several weeks of fevers and testicular pain. Workup demonstrated scrotal and prostatic abscesses. Fluid from these following surgical drainage revealed Blastomyces dermatitidis. He was treated with 12 months of oral anti-fungal therapy and repeat Blastomyces urine antigen was negative at follow up. While disseminated blastomycosis most commonly presents with pulmonary and cutaneous manifestations, genitourinary symptoms are rarely seen, but important to consider.

Blastomyces dermatitidis is an environmental fungus endemic to parts of Eastern North America that notably causes pulmonary infection in humans and other animals with the potential for extrapulmonary spread, particularly in immunocompromised hosts. However, it rarely presents with genitourinary (GU) tract involvement. Herein, we present a unique case of a 37-year-old immunocompetent male with genitourinary blastomycosis with the initial presentation of a scrotal abscess.

UNASSIGNED: And importance: The most common postoperative complications after inguinal hernia repair are hernia recurrence, hematoma, seroma, wound infection, chronic pain, numbness and swelling. The aim of this case report is to present a rare complication of inguinal hernia repair, a large scrotal abscess that was caused by an inoculated scrotal hematoma 3 months after Transabdominal Preperitoneal bilateral inguinal hernia repair.
UNASSIGNED: An 84-year-old patient presented to the emergency department complaining about fever, pain and progressive swelling of the left hemiscrotum. He had undergone a Transabdominal Preperitoneal bilateral inguinal hernia repair 3 months earlier and a scrotal paracentesis 17 days earlier due to a scrotal hematoma. The pelvic CT scan was indicative of a large abscess in the left hemiscrotum compressing the ipsilateral testicle. Surgical exploration of the inguinal area was performed and considering the patient\'s advanced age the abscess was excised \"en bloc\" with the ischemic ipsilateral testicle. The patient had an uneventful recovery and was discharged home on the third postoperative day.
UNASSIGNED: Scrotal abscess, although rare, should be considered in the differential diagnosis of scrotal pain after inguinal hernioplasty. Scrotal drainage is sometimes used in order to relive the patient\'s discomfort caused by a swollen scrotum, but if not performed properly it can lead to serious infections. Postoperatively, a suction drain or elevation and compression of the scrotum may prevent scrotal complications.
UNASSIGNED: Scrotal abscess is a rare complication of inguinal hernioplasty. Scrotal care pathways establishment after inguinal hernia repair could help reduce and manage complications.

We report a case of scrotal abscess due to urethral fistula in a paraplegic patient with spinal cord injury. On clinical examination, an urinary catheters was placed, and the left scrotal area were swollen, redness and painless. Retrograde urethrography suggested an urethral fistula with extension spreading of contrast medium into the scrotum. The case was diagnosed as urethral fistula with scrotal abscess. The patient was successfully treated with cystostomy, scrotal incision, and pus drainage. Early detection and proper management provide opportunities to improve the outcome of this disease.

BACKGROUND: The incidence of mucinous appendiceal adenocarcinomas (MAA) has increased over the past three decades. Advanced stage tumor diagnosis is likely attributable to non-specific findings. Here we describe advanced stage appendiceal MAA presenting as inguinal ulcers, scrotal abscesses, and other nonspecific symptoms. To our knowledge, this is the first report of MAA presenting as inguinal pain with inflamed phlegmonous tissue and scrotal abscess.
METHODS: A 67-year-old male presented to a rural facility complaining of weight-loss, fatigue, hematuria, dysuria, painful right inguinal ulceration, and right scrotal abscess drainage. Computed tomography of the abdomen and pelvis revealed a distended appendix (> 1.3 cm) and a fistula between the appendix, urinary bladder, right scrotum, and right groin. Laparoscopic appendectomy was performed and diagnosed as MAA. After a right hemicolectomy, the MAA was staged as pT3b pN0 M0 G2.
CONCLUSIONS: This case highlights a unique presentation of late stage appendiceal MAA. Due to the increased incidence of appendiceal MAAs, reports of unique clinical features are needed to facilitate early diagnosis and intervention, especially in rural settings with limited access to specialists.

UNASSIGNED: Primary urethral cancer is a rare disease accounting for <1% of all urological cancer cases. We encountered a patient with urethral squamous cell carcinoma diagnosed during treatment of a genital abscess.
UNASSIGNED: A 69-year-old male was referred to our hospital for recurrent urethritis and swelling of the scrotum. The genital skin was atrophic with a purulent discharge. A diagnosis of epididymitis-induced genital abscess was made, and conservative treatment was administered. However, local infection recurred and the infected tissue was resected 4 months after the first examination. The pathological diagnosis was squamous cell carcinoma. Subsequently, radical surgery was performed, but the patient died 17 months postoperatively.
UNASSIGNED: Four patients with primary urethral squamous cell carcinoma presenting as genital abscess have been reported. Careful examination is necessary while considering a malignant tumor as an underlying disease.

Gardnerella vaginalis (G. vaginalis) is the major bacteria detected in women with bacterial vaginosis (BV). Prevotella bivia (P. bivia) has been demonstrated to show a symbiotic relationship with G. vaginalis. Some men have been shown to be colonized with G. vaginalis in their urogenital or anorectal tracts, however genitourinary infections in males, including balanitis and urethritis, due to this organism appear to be much less common. In this report, we summarize previous cases of men with G. vaginalis infection, and we present a rare and unusual case of a unilateral scrotal abscess caused by G. vaginalis in co-infection with P. bivia.

Clostridium difficile infection is one of the most common causes of healthcare-associated morbidity and mortality. ExtraintestinalC. difficile infection is extremely rare; though a variety of infections involving different organs have been reported. We report the first case of scrotal abscess due toC. difficile in an 84 year old male following left inguinal herniorrhaphy. Patient underwent surgical drainage of scrotal abscess and was successfully treated with culture directed antibiotic therapy.