{"id":337,"date":"2024-01-26T15:11:20","date_gmt":"2024-01-26T15:11:20","guid":{"rendered":"https:\/\/spucnews.urgentcarepeds.org\/?p=337"},"modified":"2024-06-05T15:59:56","modified_gmt":"2024-06-05T15:59:56","slug":"case-report-2-gu-swelling","status":"publish","type":"post","link":"https:\/\/spucnews.urgentcarepeds.org\/?p=337","title":{"rendered":"Case Report 2: GU Swelling"},"content":{"rendered":"\n<p><strong>By Adenike Animasaun<\/strong><br><em>Pediatric Emergency Medicine Fellow<br>Children\u2019s National Hospital<br>Washington, DC<\/em><\/p>\n\n\n\n<p><strong>Chief Complaint<\/strong><br>Penile and scrotal swelling for \u201cmonths\u201d<\/p>\n\n\n\n<p><strong>History<\/strong><br>15 y.o. previously healthy male presenting with chronic penile and scrotal swelling. Patient has been having swelling without pain for the past few months, he is unable to say exactly when it started. The swelling has increased gradually over the past 2-3 months. He went to his PMD today due to having blisters on the scrotum that popped on Saturday with clear fluid drainage. Denies pain of the penis\/scrotum or difficulty urinating. No fever, abdominal pain, vomiting, constipation, diarrhea, dysuria, hematuria, penile drainage\/discharge, or trauma to the area. No difficulty walking. No swelling anywhere else.&nbsp; No medical or surgical history.&nbsp; No daily medication use. No known drug allergies. Up to date on vaccines.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>H: Lives at home with mom, dad, and sister. Feels safe at home.&nbsp;<\/li>\n\n\n\n<li>E: Currently in high school<\/li>\n\n\n\n<li>A: Plays football<\/li>\n\n\n\n<li>D: Denies drug, alcohol, tobacco use<\/li>\n\n\n\n<li>S: Never been sexually active&nbsp;<\/li>\n\n\n\n<li>S: Denies SI\/HI &nbsp;<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Physical with vital signs<\/strong><br>T37.4 C, HR 80, RR 20, BP 111\/75, SpO2 99% on RA<\/p>\n\n\n\n<p><strong>General<\/strong><br>Well appearing. Alert. Shy and soft spoken but interactive. Cooperative.<\/p>\n\n\n\n<p><strong>Skin<\/strong>&nbsp; <br>Warm. Dry. Intact. No rashes&nbsp;<\/p>\n\n\n\n<p><strong>Eye<\/strong><br>Pupils are equal, round and reactive to light.&nbsp;<\/p>\n\n\n\n<p><strong>Ears, nose, mouth, and throat&nbsp;<\/strong><br>No pharyngeal erythema or exudate.&nbsp;Moist mucosal membranes. Tympanic membranes clear.<\/p>\n\n\n\n<p><strong>Cardiovascular <\/strong><br>Regular rate and rhythm. &nbsp;No murmur. &nbsp;No gallop. &nbsp;Normal peripheral perfusion. Capillary refill &lt;2 sec.<\/p>\n\n\n\n<p><strong>Respiratory<\/strong><br>Lungs are clear to auscultation bilaterally. &nbsp;Respirations are non-labored. &nbsp;Breath sounds are equal.<\/p>\n\n\n\n<p><strong>Gastrointestinal<\/strong><br>Soft. Non-distended. Normal bowel sounds.&nbsp; Non-tender., No guarding or rebound. No palpable masses. No hepatosplenomegaly.&nbsp;Multiple large anal skin tags on the dorsal surface of the anus. No fissures.&nbsp;<\/p>\n\n\n\n<p><strong>Genitourinary<\/strong><br>Significant swelling of the bilateral scrotum and penis. ~1cm blister on anterior aspect of right scrotum. No tenderness of the scrotum or penis. No overlying erythema, no pustules, no ulcerations<\/p>\n\n\n\n<p><strong>Neurological<\/strong><br>No focal neurologic deficits&nbsp;<\/p>\n\n\n\n<p><strong>Urgent Care work up (labs, images, meds etc)<\/strong><br>A urinalysis was obtained and resulted as: WBC &lt;1, RBC 1, negative ketone, negative LE, negative nitrite. CBC and CMP were normal.&nbsp;<\/p>\n\n\n\n<p><strong>Brief one liner about disposition (admitted, transferred, discharged home with referral)<\/strong><br>Patient was referred to the ED for a scrotal ultrasound and labs. ESR, CRP, beta hCG, uric acid and LDH were all normal. Ultrasound found \u201cNonspecific scrotal sac\/penile soft tissue thickening without discrete cystic\/solid mass or fluid collection. Normal sonographic appearance of bilateral testicles\u201d.&nbsp; Urology consulted for possible lymphatic malformation at which time they had low suspicion for lymphatic malformation and recommend GI consult. GI consulted and upon further examination found presentation and physical exam findings concerning for possible cutaneous manifestation of Crohn\u2019s disease. They recommend outpatient follow up and dermatology follow up for blister on scrotum.&nbsp;<\/p>\n\n\n\n<p><strong>Ultimate Diagnosis&nbsp;<\/strong><br>Crohn\u2019s Disease with primarily cutaneous manifestations<\/p>\n\n\n\n<p><strong>At least 2-3 learning pearls about the diagnosis<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>There are few reports of urogenital metastatic Crohn\u2019s disease in the pediatric population. Metastatic Crohn\u2019s disease has the potential to exist in isolation of gastrointestinal findings. Urogenital manifestations of Crohn\u2019s disease in children include penoscrotal swelling, erythema, plaques, or ulcers in males. In females, vulvar swelling, fissures, and ulcers are common urogenital manifestations.<\/li>\n\n\n\n<li>About 6% of children with Crohn\u2019s disease first presented with extraintestinal manifestations. In the pediatric population, the most common presentation of metastatic Crohn\u2019s disease is chronic or recurrent penile and\/or scrotal swelling in boys.<\/li>\n\n\n\n<li>Children who present in the absence of any gastrointestinal symptoms often have difficulties in receiving the correct diagnosis, leading to delayed and\/or inappropriate management. The fact that persistent penile swelling is an uncommon pediatric condition, along with its many different etiologies, means it can be difficult for a patient who first presents to be correctly diagnosed with metastatic Crohn\u2019s disease of the genitourinary tract.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Sources<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/academic.oup.com\/ibdjournal\/article\/15\/1\/63\/4643465?login=false\">https:\/\/academic.oup.com\/ibdjournal\/article\/15\/1\/63\/4643465?login=false<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5798443\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5798443\/<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>By Adenike AnimasaunPediatric Emergency Medicine FellowChildren\u2019s National HospitalWashington, DC Chief ComplaintPenile and scrotal swelling for \u201cmonths\u201d History15 y.o. previously healthy male presenting with chronic penile and scrotal swelling. Patient has been having swelling without pain for the past few months, he is unable to say exactly when it started. The swelling has increased gradually over [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[33],"class_list":["post-337","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-winter-2024"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Case Report 2: GU Swelling - SPUC News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/spucnews.urgentcarepeds.org\/?p=337\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case Report 2: GU Swelling - SPUC News\" \/>\n<meta property=\"og:description\" content=\"By Adenike AnimasaunPediatric Emergency Medicine FellowChildren\u2019s National HospitalWashington, DC Chief ComplaintPenile and scrotal swelling for \u201cmonths\u201d History15 y.o. previously healthy male presenting with chronic penile and scrotal swelling. Patient has been having swelling without pain for the past few months, he is unable to say exactly when it started. 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Patient has been having swelling without pain for the past few months, he is unable to say exactly when it started. 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