Differential Diagnosis of Chronic Scrotal Cellulitis

The differential diagnosis for chronic scrotal cellulitis encompasses a range of conditions that can mimic its presentation. It's crucial to consider various diagnoses to ensure appropriate management and to avoid missing potentially serious conditions. The differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis

  • Idiopathic scrotal cellulitis: This is often the most common diagnosis when no specific cause can be identified. It may result from a variety of factors including bacterial infections, and its chronic nature can be due to persistent infection or inflammation.

• Other Likely Diagnoses

  • Bacterial infections (e.g., Staphylococcus aureus, Streptococcus pyogenes): These are common causes of scrotal cellulitis, especially in the acute setting, but can also lead to chronic inflammation if not fully resolved.
  • Fungal infections (e.g., dermatophytes): Fungal infections can cause chronic scrotal inflammation, especially in individuals with predisposing factors such as diabetes or immunocompromised states.
  • Contact dermatitis: Allergic or irritant contact dermatitis can cause chronic inflammation of the scrotal skin, mimicking cellulitis.
  • Eczema (atopic dermatitis): Eczema can involve the scrotum and cause chronic inflammation and skin changes.

• Do Not Miss Diagnoses

  • Testicular cancer: Although rare, testicular cancer can present with scrotal swelling and inflammation, mimicking cellulitis. It's crucial to examine the testes carefully and consider ultrasound if there's any suspicion of a testicular mass.
  • Epididymitis: Chronic epididymitis can cause scrotal pain and swelling, and it's essential to differentiate it from cellulitis, especially since it may require specific treatment, including antibiotics for bacterial causes.
  • Filarial infections (e.g., lymphatic filariasis): In endemic areas, filarial infections can cause chronic scrotal swelling and inflammation due to lymphatic obstruction.

• Rare Diagnoses

  • Granulomatous diseases (e.g., sarcoidosis, granuloma inguinale): These conditions can rarely cause chronic scrotal inflammation and should be considered in the differential diagnosis, especially if other common causes have been ruled out.
  • Scrotal manifestations of systemic diseases (e.g., erythema nodosum, Sweet syndrome): Certain systemic diseases can have scrotal manifestations that include inflammation and cellulitis-like symptoms.
  • Foreign body reactions: Rarely, the introduction of a foreign body into the scrotum can cause chronic inflammation and mimic cellulitis.

Each of these diagnoses has a different set of implications for treatment and management, highlighting the importance of a thorough diagnostic evaluation to guide appropriate care.