Bilateral Salmonella Epididymo-Orchitis as the Presenting Manifestation of Undiagnosed HIV Infection: A Case Report

Abstract

Background: Non-typhoidal Salmonella (NTS) is a predominant cause of foodborne gastroenteritis worldwide but rarely produces invasive urogenital
infections. NTS-induced epididymo-orchitis has been reported in fewer than 20 cases in the literature, all unilateral, predominantly in immunocompromised individuals. Bilateral NTS epididymo-orchitis has not previously been reported, and its association with newly diagnosed HIV infection makes this case unique.

Case Summary: A 42-year-old male presented with a 3-day history of bilateral scrotal pain, erythema, and fever. Laboratory investigations showed leukocytosis (WBC 12,100/mm³), markedly elevated CRP (19.4 mg/dL), and heavy pyuria (463 WBC/HPF). Scrotal Doppler ultrasound confirmed bilateral epididymoorchitis without abscess. Urine culture yielded Salmonella enterica, sensitive to fluoroquinolones. HIV-1/2 serology was reactive with a positive viral load (737.21 copies/mL). Oral ciprofloxacin 500 mg twice daily was administered for 4 weeks, resulting in complete clinical and biochemical resolution. No recurrence was observed at 6 months. The patient was referred for antiretroviral therapy.