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A man developed a rare complication from a COVID-19 infection, ultimately leading to a hole in his scrotum exposing the testicles inside.
Writing in Urology Case Reports, doctors report that a 72-year-old man showed up to the urology clinic, referred for a scrotal prolapse. For the last six months, he had experienced sores and ulcers on his scrotum, and was diagnosed with pyoderma gangrenosum (PG). This is a rare condition thought to be a disorder of the immune system, causing large, painful ulcers to develop on the skin.
He was placed on the steroid prednisone, which resulted in improvements to his condition.
"However, shortly after the biopsy and prior to starting prednisone, the two scrotal wounds coalesced into one large ulcer," the team wrote in their report. "This resulted in prolapse of the left testicle, which was still covered by tissue."
"After a hospitalization for congestive heart failure exacerbation, the testicle eroded through the ulcer with partial exposure of the testicle proper."
His testicle had made its way through his wounds, and was now popping out of his scrotum.
“When evaluated by urology, now with the exposed testicle, recommendations were made to place loose sutures to prevent the prolapse of the scrotal contents."
The team was able to push the exposed testicle back into place, before loosely closing the wound and allowing it time to heal. Five months after discharge, his scrotal wound had healed nicely.
"PG is a challenging diagnosis to make due to the lack of validated diagnostic criteria and is considered a diagnosis of exclusion. While laboratory workup and biopsy can be supportive of PG, these are mainly done to exclude other cutaneous ulcerative disorders," the team wrote of their diagnosis.
"While this patient had negative workup for associated systemic diseases, his recent COVID-19 infection may have contributed to the development of PG. Previous studies have shown COVID-19 can cause various immunological alterations leading to autoinflammatory diseases, such as PG."
