Case 2: An Inguinoscrotal Swelling in a Neonate at Birth: It’s Time to Expect the Unexpected

Case Presentation

A male neonate weighing 3,200 g is delivered vaginally at 38 weeks of gestation by a 38-year-old primigravida mother with an uneventful antenatal course, normal antenatal fetal scans, and no risk factors for sepsis. The neonate remains stable at birth without any need for resuscitation. A left-sided inguinoscrotal swelling measuring 2×3 cm is noticed at birth, which is fluctuant, nontender, and reducible. The rest of the systemic examination findings are normal. Breastfeeding is initiated and the infant is subsequently transferred to the maternity ward along with the mother. At 22 hours after birth, he develops a fever and is transferred to the NICU for examination and further management. He is hemodynamically stable and comfortable in room air without any signs of respiratory distress. There is no history suggesting that the fever is of environmental origin. On systemic examination, the neonate is found to be active and breathing comfortably, with a soft and nondistended abdomen. Sepsis screening is performed and a blood culture specimen sent, and intravenous antibiotics are started empirically for suspected early-onset sepsis. The neonate continues to receive exclusive breastfeeding. The inguinoscrotal swelling is noted to increase in size without any overlying induration or tenderness, and the transillumination test result is negative. His C-reactive protein is 0.30 md/dL (3 mg/L), hemoglobin is 17 g/dL (170 g/L), total lung capacity 5,500/mL, and platelet count 3.17×10³/μL (3.17×10⁹/L). Differential …