Man with Massively Enlarged Scrotum

A 67-year-old man presented with 3 days of scrotal pain, erythema, and drainage. His history included repaired aortic dissection, urinary tract infection, hypertension, dyslipidemia, benign prostatic hypertrophy, and a longstanding inguinal hernia. Examination showed a markedly enlarged scrotum (Fig 1), with maroon, tender, nonblanchable skin, and draining wounds. No abdominal distension or evident ascites was noted. Laboratory studies were significant for leukocytosis, mild transaminitis, and a high hepatitis C viral load.