Necrotising granulomatous epididymo-orchitis in the setting of Crohn's disease

Granulomatous epididymo-orchitis as an extra-intestinal manifestation (EIM) of Crohn’s disease (CD) is exceedingly rare and scarcely reported in the literature. This case involves a man in his 50s presenting with recurrent right-sided scrotal swelling resulting from persistent necrotising granulomatous inflammation on a background of ileocolonic CD maintained on infliximab therapy. Despite extensive investigation into infectious and non-infectious causes of granulomatous inflammation, along with protracted antibiotic therapy and repeated surgical intervention, symptoms failed to resolve. Following multidisciplinary team discussion, necrotising granulomatous epididymo-orchitis as an EIM of CD was proposed as the underlying aetiology driving persistent inflammation. This resulted in the commencement of ustekinumab therapy, which led to resolution of symptoms. This report provides evidence for necrotising granulomatous epididymo-orchitis as a complex manifestation of CD which is associated with diagnostic challenges, prolonged hospitalisation and significant morbidity.