Differential Diagnosis for 52 YOM with Recurring Testicular Pain

Single Most Likely Diagnosis

• Chronic Epididymitis: This condition is characterized by recurring pain in the epididymis, which is consistent with the patient's symptoms. The presence of simple epididymal cysts on ultrasound and a urine culture positive for Enterococcus faecalis suggests a possible infectious or inflammatory cause. Enterococcus faecalis is a common cause of urinary tract infections, which can lead to epididymitis.

Other Likely Diagnoses

• Urinary Tract Infection (UTI): The positive urine culture for Enterococcus faecalis indicates a UTI, which could be contributing to the patient's testicular pain. UTIs can cause referred pain to the testicles.
• Prostatitis: Prostatitis, especially chronic prostatitis, can cause testicular pain and is often associated with UTIs. The presence of Enterococcus faecalis in the urine culture supports this possibility.
• Epididymal Cyst Infection: Although the ultrasound shows simple epididymal cysts, there is a possibility that one of these cysts could become infected, leading to pain and positive urine culture results.

Do Not Miss Diagnoses

• Testicular Torsion: Although less likely given the chronic nature of the pain and the presence of epididymal cysts, testicular torsion is a medical emergency that requires immediate attention. It can present with sudden onset of severe testicular pain but should be considered in any case of testicular pain.
• Testicular Cancer: While testicular cancer is less common and might not directly relate to the infectious findings, it is crucial to consider in the differential diagnosis of testicular pain, especially in older men. Pain is not a typical initial symptom but can occur.

Rare Diagnoses

• Epididymo-orchitis due to Tuberculosis: This is a rare condition in many parts of the world but should be considered, especially if the patient has risk factors for tuberculosis or if standard treatments for epididymitis are not effective.
• Spermatocele Infection: A spermatocele is a cystic structure that contains sperm, and while less common, it could potentially become infected, leading to symptoms similar to those described. However, this would be less likely given the ultrasound findings of simple epididymal cysts.