Table 1.
Previously reported cases of epididymo-orchitis caused by Histoplasma capsulatum.
| Reference | Country | Age | Clinical manifestation | Underlying condition | Pathology | culture/serology | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
| Schuster et al., 2000 [12] | USA | 70 | Left testicular swelling for 2 weeks | Not informed | 3.5 x 2.5 × 4.5 cm mass, caseating granulomas in microscopy, GMS stain positive for budding yeast suggestive of Histoplama | Negative culture from testicular tissue; serology 1:8 by complement fixation (CF) (positive) | Left radical orchiectomy followed by oral Itraconazole 200 mg daily for 6 months | Improved |
| Kauffman et al., 1980 [13] | USA | 42 | Right scrotal swelling for 2 weeks; fever, chills, pleuritic chest pain, nonproductive cough | Not informed | Epididymis replaced by a granulomatous mass showing caseating granulomas containing budding yeasts | Serology by CF 1:32 | Surgical treatment | Improved |
| Kauffman et al., 1980 [13] | USA | 27 | Left scrotal swelling for several weeks | Not informed | Epididymis filled with purulent material; caseating granulomas on GMS staining, testicle not involved | Serology by CF 1:16. Cultures of urine and abscess material negative | Incision and drainage of abscess | Lost from follow-up |
| Monroe et al., 1974 [14] | USA | 69 | Swollen left testis | Not informed | Left testicular abscess and granuloma. GMS stain of testicular tissue possitive for Histoplasma | Postmortem adrenal culture positive for Histoplasma | Left radical orchiectomy | Deceased |
| Tichindelean et al., 2009 [15] | USA | 46 | Scrotal swelling and pain for 9 months, then weight loss, fatigue, fever | AIDS | Testicle 6.5 x 4.5 × 3.2 cm, epididymis 3 x 1.8 × 1 cm, GMS stain of testes showed granuloma with intracellular yeasts | Urine histoplasma antigen 9.9 units by EIA (positive), BAL culture grew H. capsulatum | Left radical orchiectomy, intravenous amphotericin B 0.7 mg/kg for 2 weeks + itraconazole 200 mg twice daily | Improved |
| Randhawa et al., 1995 [16] | India | 55 | Intermittent low-grade fever, cough with expectoration and weight-loss. Testicular lump for 2 years. | Pulmonary tuberculosis | Epididymitis, non-caseating granulomas, typical budding yeast forms in giant cells or interstitially. | H. capsulatum isolated from semen culture. Negative serology | Epidymectomy and 1.5 yrs of amphotericin B therapy | Improved |
| Boone et al., 1969 [17] | USA | 50 | Right lower quadrant pain; testicular pain and swelling associated with some haematuria, fever, anorexia and weight-loss. | History of mild essential HTN | Biopsy from epididymis showed intercellular yeast forms compatible with H. capsulatum | sputum and urine culture yielded H. capsulatum | Amphotericin B treatment for 30 months | Improved |
| Baig et al., 2011 [18] | India | 37 | Scrotal pain and swelling; high-grade fever of 1 week duration, and diarrhoea | Renal transplant recipient | Histopatological examination of epididymal and prostate tissues showed the presence of histoplasmosis | Pus culture from retrotrigonal abscess was positive for H. capsulatum. Urine antigen - negative | Treated with itraconazole for 6 months | Deceased due to unknown cause of massive upper genitourinary bleeding 6 months later |
| Kahn et al.*, 1992 (presented at VIII international conference on aids/iii std world congress, amsterdam, july 19–24, 1992; 8: 93) [11] | USA | 35 | Swelling of left testis and left cheek ulcer | Not informed | Biopsy specimen from orchiectomy positive for H. capsulatum | Not informed | Not informed | Not informed |
| Plazola-Hernández et al., 2020 [19] | Mexico | 22 | Solid adherent mass in posterosuperior region of the left testis | Not informed | 5 x 5 × 2.5 cm left testis and a 3.5 x 2 × 2 cm nodule, with a dark brown, irregular surface of rubbery consistency. Histopathology: fungal structures suggestive of H. capsulatum | Not performed | Left testis simple orchiectomy | Not informed |
| Botero-García et al., 2017 [20] | Colombia | 38 | Left testicular pain, swelling, erythema and fever for 1 month | Previously healthy | histopathological analysis: Hematoxylin & eosin and PAS staining showed necrotizing granulomatous epididymo-orchitis with small (2–4 μm) oval buds | Positive sperm culture for H. capsulatum; positive molecular characterization | Left orchiectomy +200 mg itraconazole every 12 h for 6 months | Improved |
| Sanha et al., 2022 [present paper] | Brazil | 66 | Enlarged and hardened right testis | AIDS | Histopathological examination of testicular liquid under GMS stain: Presence of budding yeasts compatible with Histoplasma sp. | Not performed | Right orchiecromy | Deceased |
Legend: BAL, Bronchoalveolar Lavage; CF, Complement Fixation; EIA; Enzyme immunoassay; GMS, Grocot-Gomori methenamine silver; PAS, Periodic Acid-Schiff.