April 5th, 2020

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Pretesticular and Testicular Effects of Systemic Sarcoidosis: A Case Report
Authors:  Andrew Knox, MBBCH, Neil Black, MBBCH, and Ishola Agbaje, MBBCH, Ph.D.
BACKGROUND: Sarcoidosis is a multisystem inflammatory disease of unknown etiology. It is uncommon, with an incidence of approximately 16.5 per 100,000 men.1 It is characterized by noncaseating epithelioid granulomata that typically affect the chest, skin, eyes, and, much less commonly, the genital system (<0.2% of cases). Sarcoidosis can affect any of the scrotal structures, although due to its rarity, investigation of solid masses of the testes are largely targeted towards excluding either a malignant or infective etiology.2

CASE: We report a rare case of a 27-year-old male who presented with bilateral testicular and neck swellings. He underwent orchidectomy, and histopathology demonstrated sarcoidosis. He subsequently developed both pituitary and testicular sarcoidosis resulting in azoospermia. Through the administration of gonadotropins and surgical sperm retrieval we were able to retrieve sperm suitable for assisted reproductive technologies.

CONCLUSION: This case illustrates the difficulties faced in managing the fertility of men who develop systemic sarcoidosis. It also highlights the diagnostic and therapeutic challenges faced by physicians when presented with a case of systemic sarcoidosis.
Keywords:  assisted reproductive technologies, asthenozoospermia, hypogonadotrophic hypogonadism, sarcoidosis, sperm retrieval, testicle, testicular sarcoidosis
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