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.