Scrotal Edema in a Patient with Liver Cirrhosis

Clinical Image

A 52-year-old male with a 5-year history of liver cirrhosis was admitted to our department due to intermittent haematemesis and melena for 8 days and gradually increased severity of scrotal pain for 7 days. He had alcohol abuse for 20 years. On physical examinations, bilateral scrotal edema was observed without redness (Figure 1). In addition, there were positive shifting dullness, both lower extremities swelling, and mild abdominal wall varices. On laboratory tests, white blood cell was 15.5 × 10⁹/L, percent of neutrophile granulocyte was 94.10%, hemoglobin was 34 g/L, albumin 19.8 g/L, total bilirubin was 102.7 umol/L, serum creatinine was 135.3 umol/L, and international normalized ratio was 1.79. Child-Pugh score was 14 points, and MELD score was 23.5 points. Blood bacteria culture was positive with Gram positive coccus and saliva streptococcus infection. Bedside ultrasound demonstrated pleural, abdominal, and scrotal effusion. Thus, he was diagnosed with decompensated liver cirrhosis with bacteremia. Diuretics with furosemide and spirolactone were given. Albumin or blood plasma was also infused. Twenty-two days later, lower extremities and scrotal edema relieved remarkably. And then, he was discharged.

    

    

    Figure 1: