15 January 2020

Man grows 'eggshell' around testicle because of parasitic worm

An Indian man displayed symptoms of a urinary tract infection, but the final diagnosis was unlike anything anyone suspected.

An 80-year old man from India developed a layer of eggshell-like material around his testicle. According to a report published on 6 January 2020 in the BMJ Case Reports, this happened because of a rare reaction to a chronic infection.

The man visited the doctor after experiencing symptoms similar to a urinary tract infection – blood in his urine and discomfort when passing urine.

During the examination, doctors discovered that his one testicle was enlarged and felt “hard and stony” to the touch. CT scans revealed a fluid-filled sac around his testicle – which had hardened due to calcification, like an eggshell.

According to the report, this fluid-filled sac, also called a hydrocele, is not typically found in the scrotum but can develop as a response to an infection. This sometimes happens in newborns and the elderly, especially in response to inflammation and injury.

Caused by a worm

In this case, the infection was diagnosed as lymphatic filariasis (commonly known as elephantiasis), caused by parasitic worms classified as nematodes.

Humans come into contact with the larvae of parasitic worms when they are transmitted through mosquito bites and develop into lymphatic vessels. The worms are found in tropical regions, including India where the patient lives.

According the World Health Organization (WHO), although the formation of hydroceles occurs in millions of men globally, it is very rare for the sac to calcify and form the so-called “eggshell”. According to a previous case report on the matter, the hardening of the sac can indicate a chronic infection.

The treatment

These infections are normally treated with anti-filarial drugs, but may require surgery. The authors of the case study didn't mention how this specific patient was treated.

The authors recommend that people living in areas with high risks of infections related to parasitic worms should be treated annually with anti-filarial drugs. 

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Incontinence Expert

Dr Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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