Crohn’s Disease in the Scrotum
Crohn’s disease is a chronic inflammatory intestinal pathology which can be associated to different extra-digestive manifestations such as ano-genital granulomatosis, inguinal fistula with recurrent penile, and scrotal lymphedema.
Genitourinary complications occur in 5–20% of patients with active Crohn’s disease. Isolated scrotal and penile lymphoedema as the presenting symptom of Crohn’s disease is quite unusual.
At any age
Treatment with corticosteroids and azathioprine results in significant decrease of inflammatory genital lymphedema. Fistulous tracts should be surgically removed. If the affectation involves paratesticular structures with epididymis and/or testis, orchiectomy can be indicated.
Most patients with penile and scrotal lymphedema initially respond well to steroid therapy but relapse is common. Similar results are obtained with azathioprine. Good results are also obtained with antitumor necrosis factor [TNF] therapy (Alexakis et al. 2017).
Grossly, lesion causes scrotal swelling and marked scrotal wall thickening.
Acquired lymphedema of the genitals is more frequent in elderly individuals as a consequence of pelvic/abdomen malignancy or its therapy or worldwide due to filariasis than in childhood (Murphy et al. 2001). Scrotal swelling in young boys is secondary to testicular torsion, orchioepididymitis, or idiopathic. But it can also be the first symptom of Crohn’s disease. The diagnosis of pediatric genitourinary Crohn’s disease is made taking into account the clinical data and the histological study. The medical history and physical examination can reveal a history of benign gastrointestinal complaints and perianal skin tags and fissures. Histologically, the presence of noncaseating granulomas similar to those of sarcoidosis would be required for a differential diagnosis of laboratory evaluation (angiotensin-converting enzyme and lysozyme to assess sarcoidosis). To rule out mycobacterial disease apart from the caseating morphology of granulomas, culture and polymerase chain reaction to identify mycobacterial disease as well as chest radiography (Weinberg et al. 2012) is useful.