Differential Diagnosis for Scrotal Swelling and Discharge with Necrosis
Single Most Likely Diagnosis
- Warfarin-induced scrotal necrosis: This condition is a rare but well-documented side effect of warfarin therapy, characterized by scrotal swelling, discharge, and necrosis due to the anticoagulant properties of the drug leading to hemorrhagic infarction.
Other Likely Diagnoses
- Fournier's gangrene: A severe and potentially life-threatening condition involving necrotizing fasciitis of the genitalia, which can be caused by various factors including trauma, infection, or drug-induced. It presents with swelling, discharge, and necrosis.
- Epididymitis or orchitis: Inflammation of the epididymis or testis, respectively, which can be caused by bacterial or viral infections. These conditions can lead to scrotal swelling and discharge, and if severe, may result in necrosis.
Do Not Miss Diagnoses
- Testicular torsion: A medical emergency that requires immediate attention. While it typically presents with sudden, severe pain and swelling, it can lead to necrosis if not promptly treated. The presence of discharge might be less common but could occur in the context of a missed torsion with subsequent infection.
- Scrotal cellulitis or abscess: Bacterial infections of the scrotal skin or tissues can cause swelling, discharge, and potentially necrosis if not adequately treated.
Rare Diagnoses
- Sickle cell disease complications: Patients with sickle cell disease can experience episodes of sickling in the testes, leading to ischemia and potentially necrosis. While less common, it's a consideration in patients with this underlying condition.
- Polyarteritis nodosa (PAN): A systemic vasculitis that can affect various organs, including the testes, leading to ischemia and necrosis. It's a rare condition but should be considered in the differential diagnosis of unexplained testicular necrosis.