[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-352266-105":59,"doc-detail-352266-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","immune-modulating-medications-the-masquerading-culprit-of-epididymo-orchitis","Immune-modulating medications: the masquerading culprit of epididymo-orchitis","","Immune checkpoint inhibitors (ICIs) have transformed chemotherapy for multiple malignancies, but their immune-related adverse events (irAEs) continue to be fully characterized. A male in his mid-50s with metastatic renal cell carcinoma developed bilateral epididymo-orchitis after pembrolizumab maintenance therapy. The report highlights this rarely described association and adds to the few previously published cases, serving as a caution for clinicians managing side effects of immune-enhancing medications.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/immune-modulating-medications-the-masquerading-culprit-of-epididymo-orchitis/352266/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/immune-modulating-medications-the-masquerading-culprit-of-epididymo-orchitis/352266.png","ImageObject",300,407,{"name":92,"@type":93},"Finn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-27","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Which medication was linked to the patient’s epididymo-orchitis?","Question",{"text":113,"@type":114},"The case attributes the bilateral epididymo-orchitis to pembrolizumab maintenance treatment, an immune checkpoint inhibitor (ICI).","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What was the patient’s cancer history before developing EO?",{"text":118,"@type":114},"He had metastatic renal cell carcinoma and previously received axitinib with pembrolizumab, later continuing pembrolizumab as monotherapy every 3 weeks.",{"name":120,"@type":111,"acceptedAnswer":121},"How was the diagnosis of bilateral epididymo-orchitis established?",{"text":122,"@type":114},"Doppler scrotal ultrasound initially showed right involvement, and a repeat study confirmed progression to bilateral EO with hyperaemia and epididymal enlargement.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},352266,1790331226,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","Case report  \nImmune-modulating medications: the masquerading culprit of epididymo-orchitis  \n1Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA  \n2Dayton VAMC, Dayton, Ohio, USA  \nCorrespondence to  \nDr Hari M Polenakovik; [hari.polenakovik@va.gov](hari.polenakovik@va.gov)  \nAccepted 6 December 2025  \n© BMJ Publishing Group Limited 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.  \nTo cite: Buchinsky DS, Polenakovik HM, Hakim JI. BMJ Case Rep 2026;19:e267699 . doi:10 . 1136/bcr-2025- 267699  \nDavid S Buchinsky  , 1 Hari M Polenakovik  , 1,2 Jonathan I Hakim 1,2  \nSUMMARY  \nImmune checkpoint inhibitors (ICI) have revolutionised pharmacological chemotherapy for various malignant neoplasms. The side effects of ICIs are still being fully understood. We present a case of a male patient in his mid-50s with a history of metastatic renal cell carcinoma ultimately diagnosed with bilateral epididymo-orchitis (EO) following pembrolizumab maintenance treatment. Our report adds to the three identified cases of EO linked to immune checkpoint inhibitors. This rarely reported association should serve as a cautionary tale for future clinicians about the possible side effects of these immune-enhancing medications.  \nBACKGROUND  \nImmune checkpoint inhibitors (ICIs) are the firstline pharmacological therapy in treating a wide array of neoplasms, including metastatic melanoma, metastatic renal cell carcinoma (RCC), triple-negative breast cancer and non-small cell lung  \ncancer.1–3 Programmed cell death receptor 1 (PD-1), programmed cell death ligand 1 (PD-L1) and cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) inhibitors (antibodies) are the primary subset classes of ICI pharmacological interventions that may be used.1 4 The usage of ICIs enables enhanced tumour-specific T-cell proliferation, resulting inan improved immune response.1 However, ICIs are associated with a myriad of immune-related adverse events (irAEs), including colitis, hepatitis, endocrinopathies and skin rashes.5 6 Despite well-supported evidence for possible endocrinerelated adverse side effects to ICIs, the incidence of epididymo-orchitis (EO) related to ICI treatment has been scarcely documented, with only three cases reported in the literature.5 7 8 We present this case of ICI-mediated EO to raise awareness in the field about this irAE.  \nFigure 1 Initial ultrasound of the scrotum. The right testicle measured 3.4 × 2.7 × 2.2 cm showing hypodensity and hypervascularity. The right epididymal head measured 1.1 × 1.0 cm. Right extratesticular large complex hydrocele with septations and internal echogenicity was noted. There was no evidence of varicocele. Left testicle and epididymis were normal.  \nBuchinsky DS, et al. BMJ Case Rep 2026;19:e267699 . doi:10 . 1136/bcr-2025-267699 1  \nCase report  \nFigure 2 Ultrasound of scrotum 9 days after initial ultrasound. Right testicle measured 3.8 × 2.1 × 2.3 cm. Left testicle measured 3.2 × 2.3 × 2.1 cm. The right epididymal head measured up to 2.2 cm and the left epididymal head measured 1.2 cm. Hyperaemia of both testicles and epididymides and scrotum was noted. There was bilateral epididymal body enlargement. There was a septated left extratesticular collection. The complex collection right sided extratesticular collection was of increased echogenicity relative to prior.  \nCASE PRESENTATION  \nA Caucasian male in his mid-50s with a history of stage IV RCC, coronary artery disease, chronic kidney disease stage IIIa, type II diabetes mellitus, hypothyroidism and depression presented to the emergency department with acute right scrotal swelling and a declining urinary stream. He denied any fever or chills. His pain began 11 days after his last pembrolizumab treatment. He was diagnosed with RCC in 2014 and underwent aright nephrectomy. In 2021, a biopsy of the pulmonary nodule disclosed metastatic stage IV RCC. He was treated with axitiniband pembroliz","cbCaihIXO5Lww1hW","https://ap.wps.com/l/cbCaihIXO5Lww1hW","pdf",904120,"English","# Summary\n# Background\n# Case presentation\n## Investigations and diagnosis\n## Treatment course","[{\"question\":\"Which medication was linked to the patient’s epididymo-orchitis?\",\"answer\":\"The case attributes the bilateral epididymo-orchitis to pembrolizumab maintenance treatment, an immune checkpoint inhibitor (ICI).\"},{\"question\":\"What was the patient’s cancer history before developing EO?\",\"answer\":\"He had metastatic renal cell carcinoma and previously received axitinib with pembrolizumab, later continuing pembrolizumab as monotherapy every 3 weeks.\"},{\"question\":\"How was the diagnosis of bilateral epididymo-orchitis established?\",\"answer\":\"Doppler scrotal ultrasound initially showed right involvement, and a repeat study confirmed progression to bilateral EO with hyperaemia and epididymal enlargement.\"}]","Immune-modulating medications: the masquerading culprit of epididymo-orchitis | PDF",1790098643,13]