Idiopathic Granulomatous Epididymitis
Idiopathic granulomatous epididymitis (IGE) refers to a lesion of the epididymis requiring a period of ≥6 weeks for the duration of symptoms, while others accept a period of 3 months, with no identifiable etiology (Çek et al. 2017).
Idiopathic granulomatous epididymitis is rare.
It affects the adult male usually 40–59 years old.
Typically unilateral swelling and tenderness of epididymis, usually beginning in the tail and spreading to involve the whole of the epididymis.
Some patients who were only medically treated for granulomatous orchitis have recovered, but orchidectomy in cases without a preoperatory diagnosis is the treatment of choice (Morozumi et al. 2018).
Patients with a 6 weeks or longer history of discomfort or pain in the epididymis may experience testicular pain generally without any signs of infection; induration involving the spermatic cord could be another symptom.
A mass with small white yellow nodules occurs without necrotic areas. It occurs generally as solid and unilateral nodular enlargement of the testis.
Ischemic granulomatous epididymitis at early stage presents necrosis affecting both the efferent ductules and the intertubular connective tissue. As the lesion progresses, efferent ductules are full of cholesterol crystals and giant cells with epididymal fibrosis at final stages (Nistal et al. 1997). Infectious nontubercular epididymitis is generally associated with brucella and blastomycosis: epididymal tubules have necrotic walls, and there is histiocytic infiltrate associated with squamous metaplasia. Other infective agents are fungal organisms and Gram-negative bacteria.