A middle aged man with a long history of sexual activity slowly develops testicular enlargement. Needle biopsy demonstrates the presence of obliterative endaeritis with perivascular cuffing of lymphocytes and plasma cells. A diffuse interstitial inflammation with edema and prominent plasma cell infiltrate is also present. Which of the following is the most likely diagnosis?
This is one presentation of syphilis, which can involve the testis and epididymis in both the acquired and congenital types of the disease. Characteristically, the testis is usually involved before the epididymis. Microscopically, the testis may show either gumma formation or the findings described in the question stem.Gonorrhea usually causes an acute epididymitis and orchitis with prominent neutrophils. Mumps orchitis would usually be accompanied by parotitis. Nonspecific orchitis is characterized by prominent neutrophils. Ref: Brooks G.F. (2013). Chapter 24. Spirochetes and Other Spiral Microorganisms. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
Gonorrhea
Mumps
Nonspecific orchitis
Syphilis