Giant inguinoscrotal hernia

Case history Mr HB, 69 years of age, presented with a 3 month history of progressive itchy erythematous lesions on his groin. His medical history consisted of hypertension, hyperuricemia and gastric ulcer. He also suffered from a long history of rheumatoid arthritis. Physical examination revealed a very large scrotal swelling (Figure 1). This swelling was separate from the testis, not confined to the scrotum, did not transilluminate, and increased with coughing. Erythematous plaques with an irregular margin and surrounding satellite papules were observed in groin area. Mr HB said the scrotal swelling had developed many years ago and had gradually become bigger over the past 10 years. He was seen 8 years ago and he declined any surgical intervention at this time. The size of the swelling was now compromising his mobility but he had become so accustomed to it that he felt it was not troublesome. His social life was confined mainly to his home. Mr HB also had difficulty initiating micturition, and experienced urine leakage with subsequent irritation and maceration of the surrounding skin. He denied pain, tenesmus or urgency with urination. Laboratory analyses were unremarkable. A clinical diagnosis of cutaneous candidiasis was made and radiological tests confirmed the diagnosis of giant inguinoscrotal hernia. Topical miconazole twice daily was prescribed with resolution of skin symptoms within 4 weeks.