Two of the other cases resulted post-operatively, the last in a patient receiving chemotherapy for Kaposi's sarcoma.7,8,9 HIV infection appeared to be the major risk factor in each case. Early in the disease, the pain may be out of proportion to physical findings. The skin overlying the infection may range from normal to gangrenous and under represents the severity of the underlying disease. A feculent odor characteristic of anaerobic infections may be present. Systemic findings include fever, tachycardia, dehydration, leukocytosis, thrombocytopenia, anemia, and hypocalcemia.
Children often appear nontoxic and healthy despite advanced infection and pyrexia.
All patients with fever or suspected sepsis require a thorough genitalia examination to identify potential perineal sources of infection. The differential diagnosis of a swollen, painful scrotum includes testicular torsion, testicular fracture, and hematoma. A rare cause of a swollen, painful scrotum is extension of subcutaneous emphysema from pulmonary barotrauma or pneumothorax.13 The differential diagnosis in children includes cellulitis, balanitis, orchitis, epididymitis, torsion, hydrocele, strangulated hernia, benign scrotal edema, and various skin diseases. Plain radiographs can show subcutaneous air. Escherichia coli is the predominant aerobe while bacteroides is the predominant anaerobe.