Doctors from King George's Medical University in Lucknow, India, encountered a surprising and rare condition recently. An 80-year-old man came in due to blood in his urine and symptoms pointing towards what could have been a urinary tract infection (UTI).
His problem, however, was much more severe than a UTI.
The man's right testicle was hard to the touch and very enlarged, leading the doctors to run further tests. They soon discovered they had a rare medical case on their hands.
The patient has a combination of two diseases
Upon carrying out a CT scan the doctors saw that the man's testicle was swimming in fluid – known as hydrocele in the medical world.
There was a further complication in this instance. The sac of liquid had developed a thick, eggshell-like layer of calcium all around it.
Calcification is not uncommon and kickstarts for various reasons, in this instance it was due to the growing amount of liquid around the testicle.
The build-up of fluids can be a sign of a blockage caused by parasitic infection, which is even more likely to occur in older generations and in humid, tropical locations.
Given the man in question is elderly and lives in India, the doctors hypothesized that this is what most likely had happened, with a strong chance his enlarged testicle was the result of a small filarial worm such as a Wuchereria bancrofti.
Neither calcification nor hydrocele are uncommon, but seeing them combined is the perplexing matter as this seldom occurs. The first reported case of this combination was back in 1935, and since then only a handful of cases have been mentioned.
Typically, antifilarial drugs can treat the illness, but surgery can sometimes be required.
The case was published in BMJ Case Reports on 11 December 2019.