# Immune-Mediated SARS-CoV-2-Induced Orchitis Leading to Complete Testicular Failure: A Report of a Rare Case

## TL;DR

A rare case of SARS-CoV-2-induced autoimmune orchitis leading to complete testicular failure is reported, highlighting a potential link between the virus and male infertility.

## Contribution

This paper presents a rare case linking SARS-CoV-2 infection to autoimmune orchitis and testicular failure, suggesting a 'second-hit' mechanism involving genetic susceptibility.

## Key findings

- A 40-year-old man developed azoospermia and testicular failure following asymptomatic SARS-CoV-2 exposure.
- Histological and serological evidence supported autoimmune orchitis triggered by SARS-CoV-2 in a genetically susceptible individual.
- The case suggests a 'second-hit' mechanism where viral immune activation accelerates testicular damage in vulnerable men.

## Abstract

Autoimmune orchitis is a rare cause of male infertility characterized by immune-mediated impairment of spermatogenesis. SARS-CoV-2 infection has been implicated in testicular inflammation and immune dysregulation, but reports of virus-associated autoimmune orchitis remain exceedingly uncommon. We describe a 40-year-old man with rapidly progressive infertility leading to azoospermia and testicular failure, occurring in the context of a balanced chromosomal translocation that may have conferred genetic susceptibility. Histological findings were consistent with autoimmune orchitis, and serological evidence indicated prior asymptomatic exposure to SARS-CoV-2 in the absence of recent vaccination, suggesting a potential immunological trigger. This case supports the hypothesis of a “second-hit” mechanism whereby virus-induced immune activation may accelerate testicular damage in genetically vulnerable individuals. To our knowledge, only a single-digit number of cases of SARS-CoV-2-associated autoimmune orchitis have been reported. Early fertility preservation, genetic and immunological evaluation, and long-term endocrine follow-up should be considered in men presenting with unexplained, rapidly progressive infertility. Further studies are needed to clarify the relationship between SARS-CoV-2, testicular autoimmunity, and male reproductive health.