186 SIUJ  •  Volume 3, Number 3  •  May 2022 SIUJ.ORG

CLINICAL PICTURE

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© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

COVID-19, bilateral spermatic vein, thrombosis Conflict of Interest: None declared.

Patient Consent: Obtained.

Received on December 9, 2021 
Accepted on December 11, 2021

Soc Int Urol J.2021;3(3):186

DOI: 10.48083/LMLQ3196

Bilateral Spermatic Vein Thrombosis  
Following COVID-19 Infection
Alfin Okullo,1 Philip Crispin,2,3 Daniel Gilbourd1,3

1 Department of Surgery, The Canberra Hospital, Canberra, Australia 2 Department of Haematology, The Canberra Hospital, Canberra, Australia   
3 Australian National University, Canberra, Australia

A 35-year-old male attended the emergency department 
complaining of bilateral inguinoscrotal pain. 

Two weeks prior to presentation, he had been diag-
nosed with coronavirus disease-2019 (COVID-19). On 
day 11 following COVID-19 diagnosis he developed 
bilateral groin pain.

The patient’s scrotal examination was remarkable for 
clinical grade 3 varicoceles, a finding he reported as new. 
There was moderate bilateral inguinal tenderness but no 
hernias. His blood tests showed a raised platelet count of 
426 x109/L (normal:150 to 400), white cell count of 9.7 x 
109/L (4 to 11) and haemoglobin of 146g/L. JAK2 V617F 
was not detected. An inguinoscrotal ultrasound demon-
strated absence of f low 
in his spermatic veins 
bilatera lly, with echo-
genic materia l w it hin 
the vessel lumen consis-
tent with spermatic vein 
thrombosis (Figure 1). 
A CT abdomen demon-
s t r ate d a n i nc ident a l  
18mm right renal angio-
myolipoma.

The patient was dis -
charged with a 3-month 
course of rivaroxaban. 
At a follow-up call one 
month later, his pain had 
resolved.

Bilateral spermatic vein thrombosis is a rare diagnosis 
with this being only the third case reported. All previ-
ous reported cases were associated with an underlying 
coagulation disorder and were managed with a course of 
anticoagulant therapy. In our patient, the likely predis-
posing factor was COVID-19 infection. Myeloprolifera-
tive neoplasia was considered; however, the resolution of 
the mild thrombocytosis and negative JAK2 study were 
not supportive.

COVID-19 is associated with a pro-thrombotic state 
postulated to arise from the high pro-inf lammatory 
cytokine levels. Increased platelet activation and reac-
tive hyperfibrinogenemia contribute to the prothrom-

botic state. Guidelines 
on the management of 
spermatic vein throm-
bosis a re lack i ng. In 
view of the symptoms, 
embolic risk a nd t he 
transient nature of the 
thrombotic risk factor, 
our patient was treated 
with a course of 15mg 
rivaroxaban twice daily 
for 3 weeks, and then 
20mg daily for a total of  
3 months.

FIGURE 1.

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