title: Testicular infarction secondary to protein S deficiency: a case report.
abstract: BACKGROUND
  Protein S deficiency is an inherited cause of thrombophilia. We present the second reported case in the literature of a man developing testicular infarction secondary to protein S deficiency.
  
  
  METHODS
  A 63 year old man presented with sudden onset of pain in his left hemi-scrotum. Despite oral warfarin therapy the plasma INR was only 1.4 at presentation. Doppler ultrasound scan of the scrotum confirmed absent blood flow to the left testis with increased echogenicity. Orchidectomy was performed to remove the necrotic testis. Post-operatively the patient did well and was referred to the Regional Haemophilia and Thrombosis Centre for further management.
  
  
  CONCLUSIONS
  The case highlights a rare but potential complication of protein S deficiency and demonstrates the importance of adequate anticoagulation in these patients.
authors.affiliation: The Department of Surgery, Daisy Hill Hospital, Newry, Co Down, BT35 8DR, N, Ireland, UK. dam.mckay@virgin.net
authors.forename: Damian
authors.initials: D
authors.lastname: McKay
authors.forename: Conor
authors.initials: C
authors.lastname: Marron
authors.forename: Robin
authors.initials: R
authors.lastname: Brown
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D018455:Protein S Deficiency / Q000150:complications* / Q000188:drug therapy; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin