Mr. X, a 54-year-old male, presented with severe testicular pain radiating to his abdomen along with vomiting. His medical history included diabetes for 15 years and a hernia surgery. On examination, his testicles were painful. Laboratory tests found elevated white blood cell count. Ultrasound showed normal blood flow to both testicles. He was diagnosed with orchitis and treated with antibiotics, antiemetics, and analgesics. At discharge, he was advised to continue metformin and insulin therapy.

1. CASE PRESENTATION ON ORCHITIS

2. Name: Mr. X
Sex: Male
Age: 54 years DOA: 24/10/13
Weight: 60kg
Chief Complaints:
Severe testicular pain radiating to the
abdomen
C/O vomitting.
C/O
History of Present Illness:
H/O left abdominal pain
H/O decreased appetite
Past Medical History:
K/C/O
DM 15 Years

3. Past Medication History:
Metformin-500mg,glimepiride-1mg,
Underwent surgery for right inguinal hernia since 5 years
before
Social History :
Non-Smoker, non-alcoholic, married
Physical Examination:
Patient is conscious/ oriented.
No Pallor, cyanosis, clubbing.
Normal lymph nodes.
On Examination:
Temp: Afebrile
B.P: 120/80mmHg Pulse: 80/min
System Examination:
CVS: S1S2+,
RS: NVBS
CNS: NFND
P/A: Soft, Painful

4. LAB INVESTIGATIONS
PARAMETER
OBSERVED VALUE
NORMAL RANGE
Hemoglobin
14.8g/dl
14-18g/dl
RBC
4.7millions/mm3
4.5-5.6million/mm3
ESR
21mm
5-15mm
PCV
47%
45%
DC
N-85%
Total WBC
13500cells/mm3
4000-11000 cells/mm3
MCV
91.6
80-96fl/red cells
MCH
30.2
26-33pg/cells
MCHC
33
31-36g/dl
Platelet
2,45,000cells/mm3
1,50,0004,00,000cells/mm3
Blood sugar(FBS)
202
60-100
L- 35% E-2%
N-40-75% L-30-50%
E-2-6%

5. PARAMETER
OBSERVED VALUE
NORMAL RANGE
BUN
22mg/dl
8-23mg/dl
Creatinine
0.8mg/dl
0.6-1.2mg/dl
Sodium
135mmol/l
135-147mmol/l
Potassium
4.8mmol/l
3.5-5.2mmol/l
Chloride
98mmol/l
95-107mmol/l
Bicarbonate
22mmol/l
22-30mmol/l
Total Bilirubin
0.7mg/dl
0.3-1.0 mg/dl
Direct Bilirubin
0.3 mg/dl
0.1-0.3 mg/dl
Indirect Bilirubin
0.4 mg/dl
0.2-0.7 mg/dl
Renal Function Tests:
Liver Function Tests:

6. PARAMETER
OBSERVED VALUE
NORMAL RANGE
SGOT
22U/L
12-38U/L
SGPT
34U/L
7-41U/L
Albumin
4.3g/dl
3.5 – 5.3 g/dl
Globulin
2.2g/dl
2-3 g/dl
Total protein
6.5g/dl
5.5-9.0 g/dl
Alkaline phosphatase
228U/L
84-306 U/L
Gamma GT
28 U/L
5-50 U/L
Prothrombin time
14 seconds
10-15 seconds
Urine analysis:
Colour
yellow
pH
6.0
Epithelial cells
0-2
Protein
Trace

7. OTHER INVESTIGATIONS
Visible swelling of the testicles
Culture sensitivity:
Specimen: Urine - Growth observed (Culture positive)

Urine acetone –negative
 Bleeding time -1’ 55’’
 Clotting time 4’00’’
 HbA1c: 7.2
 USG Colour Doppler:


Impression: Normal spermatic cords.
 Normal blood flow to both the testicles was observed.

8. Diagnosis: Orchitis
Drug chart:
Drugs
Dose
ROA
Frequency
No. of Days
Glibenclamide+
Metformin
2.5mg+
400mg
P/O
BD
X1
Imipenem Cilastatin
1g
IV
TDS
X3
Ondansetron
4mg
P/O
BD
X3
Rantitidine
2ml
IV
TDS
X3
Otilinium bromide
60mg
P/O
BD
X2
T. Gelusil
P/O
BD
X3
T. B complex
P/O
OD
X3
Metformin
500mg
P/O
BD
X 2 (Continued
Human Lispro Insulin
30U
SC
OD
X 2 (Continued

9. DISCHARGE ADVICE:
1. T. Metformin – 500mg – 1-0-1
2. Human lispro – 1-0-0 (30U)

10. THANK YOU