Abstract
BACKGROUND: Dengue hemorrhagic fever (DHF) is a mosquito-borne viral illness that can lead to severe bleeding complications. However, its association with the rupture of a testicular artery pseudoaneurysm due to orchitis is extremely rare. Testicular pseudoaneurysms are usually linked to trauma, infection, or inflammation. We report a unique case of spontaneous rupture of a testicular artery pseudoaneurysm in a DHF patient, leading to massive scrotal hematoma and hemorrhagic shock. CASE PRESENTATION: A 69-year-old male with DHF presented with acute right scrotal pain, swelling, and extensive bruising. Doppler ultrasonography revealed a pseudoaneurysm in the right testicular artery. The patient developed hemorrhagic shock, necessitating blood transfusions. Emergency surgery revealed a necrotic testis and a large hematoma extending to the anterior abdominal wall. An orchidectomy was performed, and histopathology confirmed hemorrhagic necrosis with inflamed blood vessels. DISCUSSION: Testicular pseudoaneurysms are rare, with spontaneous rupture being even more uncommon. While trauma and infection are recognized risk factors, dengue-associated vasculitis may have played a role in this case. The absence of prior testicular trauma or infection makes this presentation particularly unique. CONCLUSION: This case highlights a rare vascular complication of DHF. Clinicians should suspect testicular pseudoaneurysms in cases of acute scrotal pain and swelling, even without trauma. Early Doppler ultrasonography is crucial for diagnosis, and timely surgical intervention can be life-saving.