an 18-year - old male reported to outpatient department of deepa nursing home on december 13 , 2013 with the complaint of fever , malaise , myalgia , and unilateral tenderness on the right side of the face with overlying facial edema since 2 days .
the pain and swelling were associated with earache and difficulty to eat , swallow , and talk with difficulty in opening the mouth [ figure 1 ] .
swelling on the right side of the face ( frontal view ) general physical examination revealed a well - built stature .
on intra oral examination , the orifice of stensen 's duct appeared red and swollen .
past medical history revealed that the patient was hospitalized for malaria and treated without any complications 5 years back .
the diagnosis was then confirmed with positive serologic test for igm antibody , and igg antibody with a 4-fold rise in titers .
seven days following the initial symptomatic treatment for fever and parotid swelling , the patient was hospitalized for fever with a temperature of 100.7f , nausea , vomiting , and painful left scrotal swelling [ figure 2 ] .
swelling on the right side of the face ( lateral view ) the patient denied any urinary complaints of dysuria or urethral discharge . considering the patient 's age and the history , there was no record to suggest a sexually transmitted illness . on examination ,
the left testis was enlarged measuring 8 cm  7 cm  7 cm , tender and hard in consistency [ figure 3 ] .
right scrotal swelling the right testis and cord were normal . in the routine laboratory investigations
, it was observed that white cell count was raised to 11,700/mcl , and c - reactive protein to 27 mg / l .
blood and urine cultures showed no significant growth . considering the clinical examination of the scrotum which showed a swollen and edematous right testis and epididymis , features exhibiting of epididymo - orchitis ,
the patient was treated with anti - inflammatory medications , pain medications , and bed rest with an elevated scrotum and ice packs applied to the area .
clinically , mumps can be defined as an illness with acute onset of unilateral or bilateral tender , self - limited swelling of the parotid and/or other salivary gland ( s ) , without other apparent cause .
hippocrates in 5 century b.c . , described mumps as  bilateral or unilateral  swelling near the ears .
mumps is caused by an rna virus of the genus rubella virus belonging to the family of paramyxoviridae .
the mode of transmission of the viruses can be through the human reservoir by direct contact , airborne droplets , fomites infected by saliva , and possibly by urine .
the possible complications of mumps are aseptic meningitis , encephalitis , hearing loss , orchitis , oophoritis , parotitis or other salivary gland swelling , mastitis or pancreatitis .
they are the most common clinical manifestations after parotitis in adolescent boys and adult men , usually in the age group of 1529 years .
80% of all mumps orchitis cases , symptoms are first seen in the first 8 days of the parotid swelling but occasionally may precede it and rarely may manifest itself present even without the parotid swelling .
it results in severe pain , swelling , and tenderness at the affected site and is often associated with high fever , nausea , vomiting , and abdominal pain .
it resolves over a week , though , gonadal tenderness may persist for a long time . in about 2030% of cases
it can lead to oligospermia , azoospermia , and asthenospermia ( defects in sperm movement ) .
unilateral orchitis can drastically , but only briefly diminish the sperm count and alter the mobility , and morphology of the sperm .
impairment of fertility is estimated to occur in about 13% of patients while 3087% of patients with bilateral mumps orchitis experience infertility .
studies by adamopoulos et al . on the levels of various hormones in mumps orchitis , have found low testosterone levels , elevated luteinizing hormone ( lh ) levels and an exaggerated pituitary response to lh - releasing hormone stimulation in the acute phase of mumps orchitis .
after 1012 months of the acute phase of the disease the basal testosterone concentration returned to normal level but the mean basal follicle stimulating hormone ( fsh ) and lh concentrations remained significantly high . on the other hand , the link between mumps orchitis and anti - sperm antibodies has been unclear while the antibodies are suspected to impair fertility .
histologically , it has been suggested that testicular atrophy is due to parenchymal inflammation due to virus in the testicular glands leading to separation of seminiferous tubules and perivascular interstitial lymphocyte infiltration .
a barrier against edema if formed by tunica albuginea leads to rise in intratesticular pressure and pressure - induced testicular atrophy .
the use of steroid in patients with mumps orchitis is not advised as , the steroids could further lower the level of testosterone and increase the level of fsh and lh , aggravating testicular atrophy .
mumps can be prevented by immunization with measles , mumps , and rubella ( mmr ) vaccines for mmr into one shot .
the majority children who receive the vaccine acquire immunity to all three diseases ( over 99% for measles and 95% for mumps and rubella ) .
the vaccination is recommended in two doses with the first dose given at 1215 months of age . as of today
this is because the routine coverage by mmr is common which act like natural booster in vaccines .
the second dose may be given 4 weeks after the first , but it is usually given at 46 years .
a time may come in coming years when the routine coverage of mmr will go up and will lead to drastic reduction in natural infections and decrease the natural boosting , and at such a time booster of mmr at 5 years is recommended .
mumps orchitis is a severe complication of mumps which can lead to sterility in postpubertal males .
immunization and education regarding its complications is the best policy to avoid mumps - related complications .
 mumps is a relatively mild short - term viral infection of the salivary glands that usually occurs during childhood . 
 meningitis / encephalitis is a well - known complication of mumps , but involvement and infection of the testis in adolescent boys and adult men are rare . 
 we report a case of an 18-year - old male patient with mumps associated epididymo - orchitis on the left side . 
 the diagnosis was confirmed clinically and serologically by igg and igm titers . 
 the symptoms were resolved after the administration of anti - inflammatory and pain medications with bed rest and ice packs applied to the area . 
Case Report
Discussion
Conclusion