SCROTAL EDEMA From: Brad.Becker@ncal.kaiperm.org I have a 48 year old gentleman with a two year history of persistant scrotal edema following several episodes of scrotal swelling associated with fevers to 101. At initial evaluation one year ago the scrotum was grapefruit sized with significant pitting edema. Work up initially revealed a nondiagnostic ultrasound. Pelvic MRI revealed bilateral hydroceles with associated scrotal thickening. There was no evidence of intrascrotal masses, adenopathy or pelvic masses. Abdominal ultrasound and CXR were normal. At his one year follow up,the scrotum remains enlarged but with less pitting edema. PMH is only notable for polio with resultant atrophy of muscles of right leg. The patient denies any foreign travel. His only medicine is paxil. No family history of lymphedema. Any thoughts on diagnosis/treatment. ============== From: Peter Lynch I have seen several patients with scrotal edema of otherwise unexplained origin. All but one of these patients had recurring episodes of redness and fever. I believe this represents recurring cellulitis to either strep or staph. These infections lead to lymphatic vessel damage and persistent edema. At first the edema decreases after the episode of cellulitis but after two or more attacks it becomes increasingly persistent. Improvement, but not clearing, occurred with indefinite prophylactic antibiotic therapy (either dicloxacillin or erythromycin) and 24 hour per day use of an athletic supporter. ================ From: Haines Ely Patients with recurrent scrotal edema deserve an herpes titer. A high HSVII titer may indicate herpetic orchitis.The patients usually say they had recurrent penile herpes but don't anymore. Prophylaxis with zovirax is effecaceous at 400mg daily. Haines ELy, Grass Valley, Ca. ======================== From: Daniel F Mitchell The Dx sounds like elephantiasis nostras verrucosa "scroti". I'm aware of no good Tx options except covering with antibiotics if he gets cellulitis, which can go on to sepsis, and radical surgery. No hx of travel to Africa (onchocerciasis)?