ACUTE VARICOCELE THROMBOSIS AFTER VACCINATION WITH MRNA SARS-COV-2 VACCINE- A CASE REPORT

OBJECTIVES: The dilatation of the pampiniform plexus, the venous system that drains the testicle, causes varicocele. Varicocele thrombosis is rare, with few reported cases in the medical literature [1-6]. Patients may present with acute scrotal pain, mimicking a testicular torsion or strangulated hernia. Diagnosis is difficult, therefore, when based solely on clinical history and examination. Our objective is to present an unusual case of varicocele thrombosis, after Covid 19 vaccination. MATERIALS: Ultrasonography (US) with Doppler interrogation is the first-line imaging choice for diagnosis [1]. The therapeutical management is primarily conservative; however, some cases might require surgery [1,6]. The Coronavirus 2019 pandemic stimulated the development of vaccines with unprecedented speed and employing novel technologies. Serious adverse effects remained low after worldwide vaccination [7,8]. RESULTS: We report the case of a 35-year-old male patient who presented in the Urology Department accusing intense, continuous scrotal pain and swelling, with onset the next day after receiving the second dose of an mRNA Covid-19 vaccine (BNT162b2, Cominarty, Pfizer/BioNTech). There were no associated urinary signs and no fever. The patient was a healthy young man, with no known malignancy or blood dyscrasia. He could not recall suffering any local trauma between the vaccination and the appearance of the symptoms. The clinical exam revealed a tender, scrotal swelling inferior to the left testicle. The ultrasound exam demonstrated homogenous, normal echogenic testicles without changes in vascularity on Doppler US. Multiple variceal dilatations with a spontaneous diameter of up to 5 mm were observed around the left testis. The lumen of several dilated veins appeared filled with echogenic debris. The blood flow was slow in the remaining veins, with a sluggish aspect. Continuous, progressive probe compression was applied, with no complete venous collapse observed. The greyscale aspect was consistent with partially obstructing thrombi. The venous filling defects were confirmed on Colour Doppler. No signs of thrombosis were present at the level of the spermatic cord or the inguinal canal. CONCLUSIONS: Pampiniform plexus thrombosis should be considered in the differential diagnosis of acute testicular pain. This case report reveals an unprecedented etiology of varicocele thrombosis, as a side effect of an mRNA SARS-COV2 vaccine.