Salmonella bovismorbificans abscess masking a primary testicular tumour in the retroperitoneum - A case report.

INTRODUCTION AND

IMPORTANCE

Testicular tumours can present outside the testis in about 5 % of cases, including as a primary lesion within the retroperitoneal space. These arise insidiously and can be hard to detect. Salmonella is an uncommon cause of abscess formation and the subtype of bovismorbificans, arising from geckos, only scarcely reported to cause an abscess. We describe a case in line with SCARE Criteria where a retroperitoneal non-seminomatous germ cell tumour presented with a salmonella bovismorbificans abscess and subsequent bacteraemia.

CASE PRESENTATION: A 37 year old male presented unwell with fevers and right flank pain suggestive of pyelonephritis. He had a salmonella bacteraemia on initial blood cultures, subsequently isolated to be salmonella bovismorbificans, and a CT scan demonstrate a large 7.7 cm retroperitoneal mass with surrounding lymphadenopathy.

CLINICAL DISCUSSION: An initial attempt at tissue sampling failed as the lesion was filled with purulent material requiring a pig tail drain to remain in place. He progressed slowly with resolution of fevers and bacteraemia however the lesion did not reduce in size despite adequate antibiotic treatment for two weeks. A repeat core biopsy and aspiration after 19 days revealed ongoing salmonella infection with a yolk sac tumour and seminoma. His AFP markers at this time were elevated at 3330kIU/L.

CONCLUSION

A underlying malignancy should be consider when a retroperitoneal abscess fails to resolve with adequate treatment especially when a organism unknown to cause abscess is isolated.