Differential Diagnosis for Epididymitis in a 12-year-old
Single most likely diagnosis
- Epididymitis due to bacterial infection: This is the most common cause of epididymitis in children, often resulting from a urinary tract infection (UTI) that spreads to the epididymis. The justification for this being the most likely diagnosis is based on the age of the patient and the common etiology of epididymitis in prepubertal boys, which is typically related to UTIs.
Other Likely diagnoses
- Testicular torsion: Although not an infection, testicular torsion is a significant consideration in the differential diagnosis of acute scrotal pain, including epididymitis, due to its urgent nature requiring prompt intervention.
- Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can present similarly to epididymitis and is a consideration in the differential diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Testicular torsion: As mentioned, this condition requires immediate medical attention to preserve the testicle and is a medical emergency.
- Appendicitis (with an atypical presentation): Although rare, appendicitis can sometimes present with pain referred to the scrotum or testicles, especially if the appendix is retrocecal.
- Henoch-Schönlein purpura (HSP): A form of vasculitis that can cause scrotal pain and swelling, among other symptoms, and is important not to miss due to its systemic implications.
Rare diagnoses
- Tuberculous epididymitis: A rare form of epididymitis caused by Mycobacterium tuberculosis, more common in areas with high TB prevalence.
- Sarcoidosis: A systemic disease that can rarely cause epididymitis among its many possible manifestations.
- Filarial epididymitis: Caused by filarial parasites, this is rare in most parts of the world but can be seen in endemic areas.
Each of these diagnoses has a different set of implications for treatment and management, highlighting the importance of a thorough diagnostic evaluation.