Epididymo-orchitis and testicular abscess due to Nocardia asteroides complex

Nocardia asteroides complex is a rare human pathogen chiefly affecting immunosuppressed patients. We present the sixth case of epididymo-orchitis attributable to this organism. A 78-year-old man presented to the Mayo Clinic with fever and weight loss after being treated with cyclophosphamide and prednisone for an immune-mediated vasculitis. He was found to have a testicular abscess, and orchiectomy was performed. N. asteroides complex was identified on the wound cultures. Sulfa therapy was begun. In previous case reports, this condition carried a 50% mortality rate. Patients who survive seemed to benefit from aggressive surgical debridement and long-term sulfa therapy.