An unwelcome intruder: Burkholderia cepacia invades the testis in a renal transplant recipient – a rarit

Abstract

Testicular abscesses are rare complications of epididymo-orchitis and are usually caused by Staphylococcus aureus or enteric Gram-negative bacilli. The Burkholderia cepacia complex (BCC) comprises multidrug-resistant, opportunistic organisms that commonly affect immunocompromised individuals and patients with indwelling devices. Although BCC has been associated with intra-abdominal, splenic, and prostatic abscesses, testicular involvement has not been previously described. A 51-year-old man with end-stage renal disease on long-term hemodialysis through an arteriovenous fistula and two prior failed renal transplants, who presented with fever and severe unilateral scrotal pain. Imaging revealed a testicular abscess, and cultures from blood, pus, and excised tissue grew B. Cepacia. He required orchidectomy and prolonged targeted antimicrobial therapy, with complete recovery. This case illustrates an exceptionally rare genitourinary manifestation of BCC infection in a chronically immunocompromised host and underscores the need to consider opportunistic pathogens when evaluating acute scrotal conditions in transplant patients.