Discussion
Although coronavirus mainly
affects the lungs, many other organs are involved in the disease (3).
Several factors have been involved in the development of COVID-19
infection. Entry of SARS-COV-2 into target cells is a significant
determinant of coronavirus infection. Coronavirus first binds to ACE2
(angiotensin-converting enzyme 2) as a cell surface receptor, and after
viral attachment, cell surface protease activators such as TMPRSS2
(transmembrane serine protease SS2) activate coronavirus entry (4). ACE2
and TMPRSS2 are expressed in various tissues, including the male
urogenital, making it vulnerable to SARS-COV-2 infection (5). ACE2 is
present in almost all testis cells, especially Sertoli cells. Xixi Liu
et al. through single-cell transcriptome analysis of male germ cells
reported ACE2 expression in male testis (6)which reflects that the
genital system is regarded as at risk for this virus and may be a
potential target for this virus. To date, there are few reports about
male genitalia involvement in the setting of COVID-19. The first case of
orchiepididymitis associated with COVID-19 was reported in a 14-year-old
boy in Italy (7). After that, M.Haydar et al reported a case of
epididymitis in the setting of MIS-C (multisystem inflammatory syndrome
in children) in a 7- year-old boy from Syria (8). In a systematic review
conducted on 575 patients, including 538 males, scrotal discomfort,
swelling, pain, and erythema were described in 39 patients, among whom
acute orchitis was found in 10 patients and acute orchiepididymitis in
10(3). Other reported cases of genitourinary complications of SARS-COV-2
were mainly adults (9)(10)(11)(12) (Table 1). Scrotal pain is a
diagnostic challenge in children that necessitates accurate evaluation.
The most common causes of acute scrotal pain in children include
testicular torsion, appendix testis torsion, orchitis, and epididymitis.
The most important reason for scrotal discomfort is testicular torsion,
a surgical emergency that requires immediate diagnosis and treatment
(13). DUS is the choice modality for ruling out scrotal torsion from
other causes of scrotal discomfort and determining the presence of blood
flow (14). Orchitis is a local inflammation associated with abrupt onset
of testicular pain and swollen and tender testicles in examination
findings and hypoechoic and hypervascular areas in ultrasound. The
cremasteric reflex is intact, and the testis is in its normal anatomic
location. Orchitis in children usually occurs secondary to viral
infections, most commonly mumps virus. Less commonly, it is caused by
bacterial organisms, and in these conditions, orchitis occurs as a
result of the spreading of infection from epididymitis. Treatment of
orchitis depends on the underlying cause, and in viral cases, supportive
treatments such as analgesics, bed rest, hot or ice pack, and scrotal
elevation are used, and symptoms will go away on their own (15).
Conclusion : This case highlights the importance of follow-up of
COVID-19 patients and the consideration of orchitis as a consequence of
COVID-19.