Case presentation
A 7-year-old boy was admitted to our outpatient clinic with a history of fever, myalgia, diarrhea, nausea, vomiting, and severe and nonproductive coughs. Fever ceased after 4 days, but the cough continued, especially at night. Oxygen saturation was 96%, and the respiratory rate was 17 per minute. The only finding in the examination was expiratory wheezing. He had a previous history of asthma that was well-controlled. Regarding the mentioned symptoms, COVID-19 was suspected, and a nasopharyngeal swab polymerase chain reaction (PCR) test for COVID-19 was performed. COVID-19 PCR was positive. Biochemical and hematologic tests showed lymphopenia (WBC: 3400, lymph: 26%) and a mild increase in aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and D-dimer [AST: 65 (NL: < 40 IU/L), LDH: 540 (NL: < 170 Units/lit), D-dimer: 800 (NL: <500 ng/ml)]. The child underwent outpatient treatment with montelukast 5 mg daily, one puff Symbicort inhaler 160 mcg twice a day, and acetaminophen. At the follow-up visit, the patient’s symptoms resolved after 5 days, but erythematous itchy lesions on the palmar and plantar surfaces appeared, which resolved spontaneously. In the 3rd week of the disease, the child was admitted to the emergency department with swelling, pain, and erythema in one of the testicles (Figure 1).
The pain had a gradual onset and became more intense in the next days, woke up the child, and made him uncomfortable while seated. The patient had no history of recent trauma. The right testis was erythematous and tender and was located in the normal position on physical examination. There was no groin lymphadenopathy, and bilateral cremasteric reflexes were intact. Regarding severe scrotal pain to rule out torsion of the testis or testicular appendage, a color Doppler ultrasound (DUS) was performed which shows edematous scrotal wall thickening and extensive hyperemia of the right testicle that all are indicative of orchitis (Figure 2).
The patient was diagnosed with orchitis associated with COVID-19 and underwent conservative treatment. In the periodic follow-up, the pain was reduced, and it was completely resolved approximately two weeks later.